013423054-7-6-2022-52-CC-MOTI-CG3TT4-20220706150008

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423054
Report Date: 07/06/2022
Date Signed: 07/06/2022 03:00:14 PM

Document Has Been Signed on 07/06/2022 03:00 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GENIUS KIDS DOUGHERTY		FACILITY NUMBER:	013423054
ADMINISTRATOR:	PUJA SARAF		FACILITY TYPE:	850
ADDRESS:	6044 DOUGHERTY ROAD		TELEPHONE:	(925) 999-9575
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	30	CENSUS: 2	DATE:	07/06/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ranjini Venkatachari & Anitha Kannan		TIME COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A Case Management Visit was conducted today 07/06/2022 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Owners/Applicants Ranjini Venkatachari, Anitha Kannan. The applicants have submitted an application for a change in time base from PART TIME to FULL TIME care with use of an outdoor waiver. Program is located within a plaza. The facility will also have a Heritage School on site, which will be located in the back room where the kitchen and bathrooms are located. The preschool program will operate from 7:30AM - 6:30PM, Monday through Friday in the front space upon entrance. Preschool consists of 3 classrooms (D101, E107, and C5) and an indoor play area A health and safety inspection was conducted inside and the measurements are as follows: INDOORS: 2740.23 square feet = 45 children OUTDOORS: NO YARD The center has obtained an approved fire inspection clearance from the Dublin Fire Department on 6/2/2022. The preschool program does not have a play yard, but does have indoor motor skills room, and an outdoor yard waiver will be on file. LPA and Owners discussed, in depth, the waiver conditions. Owners understand that all staff are to follow all conditions listed within outdoor yard waiver. LPA and Owners toured the playground/park and walked the walking field trip path. The Owners/Director are reminded that the preschool program may never commingle with the Heritage School. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 3 toilets, 1 urinal and 2 sinks available for children. The teacher's desk area and the staff toilet will serve as isolation areas for sick children. There is a food prep area which is inaccessible to the children.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GENIUS KIDS DOUGHERTY	FACILITY NUMBER: 013423054
	VISIT DATE: 07/06/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The preschool program has a water dispenser and cups available to children. The center will provide snacks. No cleaning agents were found stored with food. There is a microwave, refrigerator and toaster over available. First aid supplies are available in the center. There is a working telephone on site. The sign in/out sheets are now electronic and each individual has a unique identifier.

Deepa Shah is a fully-qualified preschool director and will have completed 16 hours of health and safety training including pediatric CPR and First Aid which is valid and current.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair.

A license for 30 full time preschool aged children will be issued effective today's date, 7/6/2022.

Exit interview conducted with Ranjini Venkatachari & Anitha Kannan. Notice of Site Visit most be posted for the next 30 days.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

LIC809 (FAS) - (06/04)

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