013423478-2-14-2020-52-CC-JWIS-BLSPLT-20200214102515

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423478
Report Date: 02/14/2020
Date Signed: 02/14/2020 10:25:21 AM

COMPREHENSIVE INSPECTION

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:	GUPTA, POOJA		FACILITY NUMBER:	013423478
ADMINISTRATOR:	GUPTA, POOJA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 242-4686
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	14	CENSUS: 6	DATE:	02/14/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Licensee - Pooja Gupta		TIME COMPLETED:	10:30 AM

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	On 02/14/2020, Licensing Program Analyst (LPA) Jonathan Williams met with Licensee Pooja Gupta for an Required 1 Year Inspection. Present for this inspection are six children in care (five preschoolers, including the Licensee's daughter, and one infant), the Licensee, and one fingerprint cleared assistant provider (Swathi Yarava). The facility was toured to conduct a Health and Safety Inspection. The home is a two story home and is tidy and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the downstairs living room, kitchen, "child care room 1" (located to the right side of the main entrance), "child care room 2" (located next to "child care room 1"), bathroom in "child care room 2", and backyard. The OFF LIMIT AREAS are the entire second floor, garage, and bathroom located near the main entrance next to the stairway, all of which will be made inaccessible to children by closed and/or locked doors, barricade, and visual supervision. The ISOLATION ROOM is "child care room 2". The backyard is fenced. There are toys and learning materials in the facility. There are no pools, hot tubs, ponds, or any other bodies of water in the on-limits areas during today's inspection. All hazardous materials and toxins were observed to be made inaccessible to children during today's inspection. Per Licensee, there are no firearms kept in the home. The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Both Licensee and assistant provider have current CPR/1st Aid training which expire on 01/12/2021 and 04/13/2021, respectively. Mandated Reporter Training for Licensee and assistant provider expire on 01/14/2021 and 04/14/2021, respectively. There is a fireplace in the home which is screened to prevent access to children. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. Facility roster was obtained. See 809-C for continuation.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020

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: GUPTA, POOJA	FACILITY NUMBER: 013423478
	VISIT DATE: 02/14/2020

NARRATIVE

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Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprinted, obtain a criminal record clearance, and be associated to this facility prior to being in the presence of children in care.

Licensee was reminded that any failure to comply with these regulations will result in an immediate assessment of civil penalties of $100 to $3000 per person, per incident. Licensee was reminded of her responsibilities as a Mandated Reporter. Licensee was directed to the website where Mandated Reporter trainings can be accessed: www.mandatedreporterca.com. Licensee was reminded to take both required Mandated Reporter trainings every two years, which are titled "General" and "Child Care Providers". Licensee was directed to the following online resources where CCLD forms can be downloaded: www.ccld.ca.gov.

Individual Medical Services (IMS) policy was discussed. Licensee was reminded that when any IMS is provided, a Plan for Providing 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 and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. Per Licensee, no IMS is provided at this time.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee and LPA reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Appeal rights were provided to the Licensee. Exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020

LIC809 (FAS) - (06/04)

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