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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406817
Report Date: 02/11/2022
Date Signed: 02/11/2022 03:00:11 PM

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:SHARMA, KUMUDINI & RAJESHFACILITY NUMBER:
073406817
ADMINISTRATOR:SHARMA, KUMUDINIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 230-8614
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY:14CENSUS: 2DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Kumudnin & Rajesh SharmaTIME COMPLETED:
02:57 PM
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On 2/11/2022 at 1:09pm Licensing Program Analyst (LPA) Morgan Pringle met with Kumudnin & Rajesh Sharma for an Unannounced Annual Inspection. Present during the inspection were the Licensees, one (1) infant, and one (1) preschool age child. Licensees stated that their two (2) adult sons no longer reside in the home. Licensees home was toured for a health and safety inspection. The facility operates 8:00am – 6:00pm, Monday - Friday.

ON LIMITS AREA: Family Room, Dining Room, Living Room, Porch, Downstairs Half Bathroom and Backyard


OFF LIMITS AREA: Entire 2nd Floor, Den, Downstairs Bedroom and Bathroom, Kitchen and Garage
ISOLATION AREA: Family Room, Dining Room or Living Room

The facility is a two story home owned by the Licensees. The inside of the home was observed to be neat and clean with ample age appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas.

The home has one (1) fully charged 3A40BC fire extinguisher in the kitchen. There is one (1) working smoke detector in the family room and dining room. There is one carbon monoxide detector in the downstairs hallway. The home is equipped with central heat and air for proper ventilation. The staircase is gated making it, and the 2nd floor, inaccessible to the children in care. The electric fireplace in the family room is not in use, does not open, and does not get hot to the touch making it no danger to the children in care. LPA did not observe any bodies of water in or around the home that could be a potential danger to the children in care. Licensees stated that there are no firearms and one (1) dog in the home.

Continued on LIC809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: SHARMA, KUMUDINI & RAJESH
FACILITY NUMBER: 073406817
VISIT DATE: 02/11/2022
NARRATIVE
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The Licensees Health and Safety training has been completed and CPR and First Aid training is complete with an expiration date of 5/7/2023 and 5/1/2023. Licensees Mandated Reporter training is complete and expires on 12/26/2022. All required forms are posted and visible for public view in the living room. LPA obtained the children’s files, three (3) assistants files, and the facility roster. All files were complete. LPA obtained the fire/disaster drill log. Log is complete with the last drill logged 1/3/2022.

Licensees was reminded that California Law requires Licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensees that all forms can be downloaded at www.ccld.ca.gov. Licensees was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com.

Licensees was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensees is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 (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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
Continued on LIC809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SHARMA, KUMUDINI & RAJESH
FACILITY NUMBER: 073406817
VISIT DATE: 02/11/2022
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Licensees was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensees and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensees of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Kumudnin & Rajesh Sharma.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC809 (FAS) - (06/04)
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