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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627710
Report Date: 09/13/2021
Date Signed: 09/13/2021 02:31:09 PM

Document Has Been Signed on 09/13/2021 02:31 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:DEBNATH, MOUMITA FAMILY CHILD CAREFACILITY NUMBER:
376627710
ADMINISTRATOR:MOUMITA DEBNATHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 728-6560
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
09/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Licensee, Moumita Debnath TIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA), Jennifer Lott conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Licensee, Moumita Debnath and granted entry after identifying herself and disclosing the purpose of her visit. The licensee is using the following areas for daycare: Family room, living room, dining room and backyard. Off limit areas include: All upstairs and garage. Business Hours are: 8:30am-5pm M-F. The facility currently has 10 children in care. Licensee provided a copy of their current roster and is operating within the licensed ratio and capacity.

At 11:00am LPA tested the carbon monoxide / smoke detector detector located in the dining room area. Both devices were functional. Licensee Debnath advised there are no bodies of water on the premises and LPA did not observe any bodies of water on the premises. Licensee, Debnath advised there are no firearms or ammunition stored on the premises.

There are no open face heaters/fireplaces. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible to children. Outdoor play area is fenced and free of hazards. The last disaster/fire drill was conducted on 04/01/2021. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials.

Children’s records contained emergency contact information and immunization records. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: DEBNATH, MOUMITA FAMILY CHILD CARE
FACILITY NUMBER: 376627710
VISIT DATE: 09/13/2021
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A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemption. Pediatric CPR and First Aid cards are current and will expire on 08/2023. All staff have completed the mandated Child Abuse Reporting as per AB1207 through 04/2022. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

Licensee was also provided handouts with information regarding Safe Sleep Regulations/SIDS, Lead Exposure, and Shaken Baby Syndrome. LPA and Licensee discussed California Megan’s Law and LPA provided the website of: www.meganslaw.ca.gov . LPA discussed and provided Licensee with the following: Child Care Advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements, contact the Child Care Licensing Duty Line at (619) 767-2248.

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.

Based on today’s visit, no deficiencies were observed at this time. An exit interview was conducted with licensee, Debnath. A copy of this report, Appeal and Licensee Rights (LIC 9058) as well as Notice of Site Visit Form (LIC 9213) have been provided. Signature below confirms receipt of these documents. Licensee acknowledges that the LIC 9213 is required to be posted for 30 days. LPA observed the Licensee post the LIC 9213 notice of site visit.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021
LIC809 (FAS) - (06/04)
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