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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422083
Report Date: 08/29/2024
Date Signed: 08/29/2024 03:14:07 PM


Document Has Been Signed on 08/29/2024 03:14 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:SINGH, RENUFACILITY NUMBER:
013422083
ADMINISTRATOR:SINGH, RENUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 431-8736
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:14CENSUS: 4DATE:
08/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee, Renu Singh TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee Renu Singh for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. During this inspection, the Licensee and helper were supervising four (4) preschoolers. The Licensee lives in the house with her husband and two children. The two-story home has five bedrooms, 4.5 bathrooms, a living room, a family room, a kitchen, a dining room, a laundry room, a loft, an attached garage, an in-law suite, and a backyard. The facility currently operates Monday- Friday, 8:45 am – 5:00 pm. The facility has liability insurance through Accord Insurance.
ON-LIMIT AREAS are the living room, family room, dining room, kitchen, bathroom, and in-law suite, which consists of two rooms and a bathroom. The in-law suite is the primary daycare area.
OFF-LIMIT AREAS are the entire second floor and garage.
During the inspection, the Licensee informed the LPA that there was a power outage from 9:00 to 11:00 a.m. today. LPA reminded the Licensee of the reporting requirements for any unusual incidents or injuries to children in the care to notify the 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 to the Regional Office by phone, and the written report, LIC 624B, must be within seven business days.
LPA observed the daycare Area is clean, orderly, and equipped with age-appropriate toys. The home has a working telephone, a smoke and carbon monoxide detector, and a fire extinguisher meeting the minimum requirements. During today's inspection, LPA did not observe any bodies of water. There is a fireplace in the living room which is not in use. The Licensee conducts and documents Fire/Disaster Drills; the log indicates a drill was conducted on 04/24. There are child-size tables and chairs for snacks and activities. There are ample age-appropriate toys that appear to be safe and in good condition. A child safety gate is located at the bottom of the stairs to prevent access to the stairs and upper levels for children in care.
see next page..
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SINGH, RENU
FACILITY NUMBER: 013422083
VISIT DATE: 08/29/2024
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 Each child has a separate blanket and cots. The Licensee states there are no guns or weapons in the home. There are no pets in the home. The outdoor play area is fenced. The Licensee and helper's CPR/FIRST AID expires on 2/04/2025. The Licensee provides daily snacks, and children are required to bring their lunch. LPA reviewed children's files. All the files are complete. All required postings are properly posted. The roster was reviewed.

Licensee 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 licensee 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 licensee 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.


Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com
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/inspection-process.

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

No deficiency was cited today.

Exit interview conducted and report was reviewed with the licensee, Renu Singh.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC809 (FAS) - (06/04)
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