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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408409
Report Date: 06/15/2021
Date Signed: 06/15/2021 12:04:15 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:BISHT, RUPIKAFACILITY NUMBER:
073408409
ADMINISTRATOR:BISHT, RUPIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 858-6329
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY:14CENSUS: 8DATE:
06/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rupika BishtTIME COMPLETED:
12:01 PM
NARRATIVE
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On 6/15/2021 at 9:15am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Rupika Bisht for an unannounced annual inspection. Present during the inspection was licensee Rupika Bisht, her fingerprint cleared husband Bhalendra Bisht, her 11-year-old son, and their 15-year-old son who is her Assistant Provider. There are eight (8) preschool children present today. The Licensee’s home was toured for a health and safety inspection. The operating hours are 9:00pm – 5:00pm Monday – Friday.

ON LIMITS AREA: Living Room, Family Room, Kitchen, Downstairs Bedroom, Dining Room, Downstairs Bathroom, Open Courtyard, and Backyard


OFF LIMITS AREA: Staircase, Garage, Laundry Room, and entire 2nd floor
ISOLATION AREA: Family Room

The facility is a two-story home owned by the Licensee. The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms and one (1) small dog.

The home has one (1) fully charged 2A10BC fire extinguisher located in the nook of the kitchen. One (1) working carbon monoxide /smoke detector combination located in the hallway and one (1) smoke detector in the bedroom, the hallway next to the bedroom and living room. The fireplace in the living room is locked and inaccessible to the children in care. The home is equipped with central heating and air for proper ventilation. LPA observer no bodies of water in or around the home.

The Licensee’s Health and Safety training has been completed and CPR and First Aid training is current and will expire 3/12/2023. Licensee’s Mandated Reporter Training was completed on 3/13/2021. Cont on 809-C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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 4
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: BISHT, RUPIKA
FACILITY NUMBER: 073408409
VISIT DATE: 06/15/2021
NARRATIVE
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At 10:00am LPA obtained the facility roster and requested the files for all eight (8) children. There are five (5) children in care that are not recorded on the facility roster. The fire drill log has been completed on 6/9/2021.

Licensee 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 Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.



Incidental Medical Services (IMS) policy was discussed as well. Licensee was reminded that when any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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 $3,000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter.
Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six months and documented. The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

Cont on 809-C

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

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: BISHT, RUPIKA
FACILITY NUMBER: 073408409
VISIT DATE: 06/15/2021
NARRATIVE
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This report was read and given to the Licensee for a signature. There is one (1) deficiency being cited today. This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: BISHT, RUPIKA
FACILITY NUMBER: 073408409
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/15/2021
Section Cited

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102417(g)(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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This requirement was not met as evidenced by: Licensee has not updated the facility roster. There were five (5) children in care missing from the roster.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4