<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421742
Report Date: 07/28/2021
Date Signed: 07/28/2021 03:50:58 PM

Document Has Been Signed on 07/28/2021 03:50 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SINGH, MAMTAFACILITY NUMBER:
013421742
ADMINISTRATOR:SINGH, MAMTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 770-1246
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Mamta SinghTIME COMPLETED:
04:05 PM
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 7/28/2021 at 2:30pm, Licensing Program Analyst (LPA) Jonathan Williams met with Licensee, Mamta Singh, for a Required 1 Year Inspection. Present for this inspection are the Licensee, one fingerprint cleared and associated assistant, and ten children in care (four infants and six preschoolers). The facility was toured to conduct a Health and Safety Inspection.

The home is a 1-story home. The ON LIMIT AREAS are sleep area, kitchen, living room, garage, bathroom closest to sleep area, and backyard. The OFF LIMIT AREAS are master bedroom/bathroom, first bedroom on the right of the hallway, and first bedroom on the left of the hallway, all of which will be made inaccessible to children by closed and/or locked doors, barricade, and visual supervision. The ISOLATION ROOM is either the sleep area or the backyard, depending on weather conditions.

The interior of the home was toured at 2:30pm. LPA observed the home to be tidy and clean with heating and ventilation for safety and comfort. There are toys and learning materials in the facility. All hazardous materials and toxins were observed to be made inaccessible to children during today's inspection. LPA observed the kitchen to be clean, in good repair, and free of sharp or dangerous items accessible to children during this inspection. Per Licensee, there are no firearms kept in the home. Per Licensee, there are no pets kept in the home.

The backyard was toured at 2:45pm. LPA observed there to be no pools, hot tubs, ponds, or any other bodies of water on the facility premises during today's inspection. LPA observed the backyard to be free of dangerous or age-inappropriate items at this time.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
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 2
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: SINGH, MAMTA
FACILITY NUMBER: 013421742
VISIT DATE: 07/28/2021
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
26
27
28
29
30
31
32
The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee has current CPR/1st Aid training certificate which expires 6/2023. CPR/1st aid training certificate for assistant expires 11/2022. Mandated Reporter Training for Licensee expires on 7/18/2023. Mandated Reporter training for assistant provider expires on 7/18/2023. The facility is in ratio today. Children's files were reviewed for proper documentation. Facility roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS at this time. 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 was 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 reminded that California Law requires licensed Family Child Care Home 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 624b). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded 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.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee. 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2