073407162-10-18-2019-52-CC-JPLA-BH3MRX-20191018095103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407162
Report Date: 10/18/2019
Date Signed: 10/18/2019 09:51:08 AM

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:	SRIVASTAVA, SHALINI		FACILITY NUMBER:	073407162
ADMINISTRATOR:	SRIVASTAVA, SHALINI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 556-9265
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY:	14	CENSUS: 11	DATE:	10/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Shalini Srivastava		TIME COMPLETED:	10:05 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	Licensing Program Analyst (LPA) Julia Placencia arrived for an unannounced Annual/Random Inspection, and met with Licensee Shalini Srivastava. Present for this inspection were 11 preschool age children, and fingerprint cleared helpers Karpagam Srinivasan and Sumi Pothen. Also residing in the home are the licensee's fingerprint cleared spouse and 14 year old daughter. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am to 6:00pm. ON LIMITS: Downstairs bedroom/bathroom, dining room, in-law unit, backyard. OFF LIMITS: Remaining rooms on first floor, entire second floor, garage. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. The home is two story, which is neat and clean, with heating and ventilation for safety and comfort. There are no stairs in the on limits area. The outdoor play area is fenced, and is free from defects and dangerous conditions. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Fire extinguisher, carbon monoxide and smoke detector meet State Fire Marshall standards. The fireplace is not in the on limits areas. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 7/3/19. All required licensing documents are posted and visible for public review. At 9:10pm, children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. The licensee's Pediatric CPR/First Aid certificate is current, expiring on 2/9/21, and the helpers' expires 4/6/21. Licensee and helpers have proof of the required immunizations. Safe Sleep practices were discussed, and new car seat laws were provided. Licensee was reminded that children are never to be left in a parked vehicle. The licensee was advised of the required mandated reporter training to be completed as of 1/1/18, at www.mandatedreporterca.com. ***Continued on LIC809C....

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

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: SRIVASTAVA, SHALINI	FACILITY NUMBER: 073407162
	VISIT DATE: 10/18/2019

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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.

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 fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

There were no deficiencies cited during today's inspection. This report shall remain on file for 3 years. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days.

Exit interview conducted with Shalini Srivastava. Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

LIC809 (FAS) - (06/04)

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