013423054-12-14-2022-52-CC-JSAI-CM4QSZ-20221214112621

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423054
Report Date: 12/14/2022
Date Signed: 12/14/2022 11:26:40 AM

Document Has Been Signed on 12/14/2022 11:26 AM - 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:	GENIUS KIDS DOUGHERTY		FACILITY NUMBER:	013423054
ADMINISTRATOR:	PUJA SARAF		FACILITY TYPE:	850
ADDRESS:	6044 DOUGHERTY ROAD		TELEPHONE:	(925) 999-9575
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	30	CENSUS: 16	DATE:	12/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Director, Deepa Shah		TIME COMPLETED:	11:50 AM

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	Licensing Program Analyst (LPA) Jyoti Saini met with Director Deepa Shah for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. The facility owner Ranjini Venkatachari arrived during the inspection. The facility operates under two preschool programs; 9:00am-12:00pm and 8:00am-6:00pm and the facility also operates after school program under the heritage license from (12:00 pm- 6:00 pm). The facility consists of 3 classrooms (D101, E107, and C5) and an indoor play area. Present for today's inspection are 4 fingerprints cleared and associated staff members and 16 children in care. The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed; There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. The children and staff have a separate bathroom. There are 3 toilets, 1 urinal and 2 sinks available for children. The bathrooms appear to be safe, sanitary, and free of any hazardous items. There is drinking water readily available through water fountain and water bottles brought from home. The facility only provides snacks and there is a menu posted for the entire month. The classroom has appropriate postings. The last Emergency Drill was conducted on 09/15/2022 at 11:05 am and is properly logged. The preschool program does not have a play yard, but does have indoor motor skills room, and an outdoor yard waiver which is posted by the entrance. The Owners/Director are reminded that the preschool program may never commingle with the Heritage School. LPA reviewed sign-in and out sheet. The center has a complete record of sign-in/out sheets by an authorized pick up person. There are first aid kits available. There is a working fire alarm system at the elementary. The room has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available. All children have a record of emergency identification information. Staff records reviewed were complete. All staff has a criminal record clearance on file. The site Director and staff has a current Pediatric First Aid/CPR certificate on file. All of the staff has taken Mandated Reporter training except S1. see next page..

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

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 5

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: GENIUS KIDS DOUGHERTY	FACILITY NUMBER: 013423054
	VISIT DATE: 12/14/2022

NARRATIVE

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During inspection,

Director was reminded that all adults 18 and over, 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 Child Care Center. 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.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children currently. If 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

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/process.

The attached type B deficiency is cited today.

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

Exit interview conducted and report was reviewed with the director, Deepa Shah.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5

Document Has Been Signed on 12/14/2022 11:26 AM - It Cannot Be Edited

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: GENIUS KIDS DOUGHERTY	FACILITY NUMBER: 013423054
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. LPA osberved that S1 does not have required immunization (influenza, pertussis, and measles) on the file. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/13/2023
	Plan of Correction
1 2 3 4	Licensee shall obtain immunization records for the staff and submit copies of documenation to LPA by the POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: GENIUS KIDS DOUGHERTY	FACILITY NUMBER: 013423054
	VISIT DATE: 12/14/2022

NARRATIVE

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During inspection,

Incidental Medical Services (IMS) policy was discussed. This facility provide IMS (Incidental Medical Services) to children currently. If 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

The attached type B deficiency is cited today.

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

Exit interview conducted and report was reviewed with the director, Deepa Shah.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5