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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422324
Report Date: 06/12/2024
Date Signed: 06/12/2024 03:09:17 PM

Document Has Been Signed on 06/12/2024 03:09 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:SRIVASTAVA, JYOTIFACILITY NUMBER:
013422324
ADMINISTRATOR/
DIRECTOR:		SRIVASTAVA, JYOTIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 894-1322
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
06/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Licensee,Jyoti SrivastavaTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee Jyoti Srivastava 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 supervising 11 children (two infants and nine preschoolers). The Licensee lives in the house with her husband and two children. The two-story home has three bedrooms, three bathrooms, a living room, a family room, a kitchen, a dining room, a laundry room, a den, a garage, and a backyard. The hours of operation are 9:00 am to 5:30 pm, Monday -Friday. The facility has liability insurance through Markel insurance.
Daycare area: The entire first floor consists of a living room, dining room, family room, kitchen, den (the main daycare area), bathroom, and backyard.
Off-limit areas: the entire second floor and garage. All off-limit areas are inaccessible by closed and/or locked doors and visual supervision.
LPA inspected the house for health and safety hazards. The daycare Area is clean, orderly, and equipped with age-appropriate toys and equipment for children, indoors and outdoors. The home has a working telephone, a smoke and carbon monoxide detector, and a fire extinguisher. There are no bodies of water in the daycare area. There is a fireplace in the living room, which is not in use. A child safety gate is located at the bottom of the stairs to prevent access to the stairs and upper levels of the house. There are child-size tables and chairs for snacks and activities. The Licensee is reminded that NO walkers, exersaucers, jumpers, bouncers, or any similar items are to be used for children in care and shall be made inaccessible. The napping cots are in good condition, and each child has a separate blanket. The parents wash the blankets weekly. The Licensee states there are no guns or weapons of any kind in the home. There are no pets in the house. The outdoor play area is fenced. There is wooden play structure securely anchored to the ground, which includes slide and tire swing. The Licensee and her helper have valid CPR. The Licensee provides daily snacks and meals. Discipline policy is redirection. The Licensee conducts and documents fire and disaster drills twice a year, and the last drill was conducted on 5/2024. All required postings are correctly posted. The facility has a complete record of 15 minutes sleep check.
See the next page.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SRIVASTAVA, JYOTI
FACILITY NUMBER: 013422324
VISIT DATE: 06/12/2024
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LPA reviewed 11 children’s files. All children have a record of emergency identification information and immunization record on file.

During Inspection, 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

There are no deficiencies cited today.

Exit interview conducted and report was reviewed with the licensee, Jyoti Srivastava.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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