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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700036
Report Date: 09/16/2021
Date Signed: 09/16/2021 04:05:14 PM

Document Has Been Signed on 09/16/2021 04:05 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:KAUR, KAMALPREET & SARN, RANJODHFACILITY NUMBER:
015700036
ADMINISTRATOR:KAUR, KAMALPREETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 676-5744
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
09/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Kamalpreet KaurTIME COMPLETED:
04:20 PM
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On 9/16/2021 at 12:55pm, Licensing Program Analyst (LPA) Jonathan Williams met with Licensee (Kamalpreet Kaur) for a Required 1-Year Inspection. Present for this inspection are the Licensee, the Licensee's fingerprint cleared and associated assistant, and ten napping children in care (three infants and seven preschoolers). Facility operating hours are 8:30am-6:00pm M-F. The facility was toured to conduct a Health and Safety Inspection.

The home is a 1-story home. On-limit-areas: the living room, two bedrooms on the right side of the hallway, bathroom at the end of the hallway, kitchen, backyard.
Off-limit areas: Garage, master bedroom. master bathroom. Isolation room: bedroom closest to on-limit bathroom.

At 12:59pm, LPA toured the facility interior. The home is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the home. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children.

At 1:15pm, LPA toured the facility bathroom. Toilets and sinks were found to be in operable condition. LPA observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. No cleaning supplies were observed to be accessible to children during today's inspection.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KAUR, KAMALPREET & SARN, RANJODH
FACILITY NUMBER: 015700036
VISIT DATE: 09/16/2021
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At 1:21pm, LPA toured the outdoor play area. All play equipment was observed to be operable and age-appropriate during this inspection. A concrete area next to a rock climbing wall lacked cushioning material to absorb a fall. No pools, hot tubs, ponds, or any other bodies of water are on the facility premises at this time.

The facility has a fully charged 2A10BC fire extinguisher and working telephone. Smoke/carbon monoxide detectors are fully functional, per Licensee. CPR/1st Aid certificate for Licensee expired 9/14/2021. Mandated Reporter training for Licensee expired on 5/17/2021. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view. Facility roster was obtained. Facility conducts fire/disaster drill at least once every 6 months.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care 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 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.

Licensee was reminded that California Law requires licensed Family Child Care Homes 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KAUR, KAMALPREET & SARN, RANJODH
FACILITY NUMBER: 015700036
VISIT DATE: 09/16/2021
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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.

There are two type B deficiencies cited. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided to the Licensee and the signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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Document Has Been Signed on 09/16/2021 04:05 PM - It Cannot Be Edited


Created By: Jonathan Williams On 09/16/2021 at 03:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KAUR, KAMALPREET & SARN, RANJODH
FACILITY NUMBER: 015700036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above. LPA observed that a rock climbing wall is located next to exposed concrete with inadequate amount of cusioning material to absorb falls. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2021
Plan of Correction
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Climbing structure mentioned above shall remain off-limits until cushioning material is obtained. Licensee shall submit photographic evidence of correction to LPA by the POC due date.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Assistant provider present during visit lacked immunzation records. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2021
Plan of Correction
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Licensee shall obtain the above mentioned immunization records for assistant and submit copies to LPA for review. Licensee shall maintain copies on file for review by LPA. Licensee shall correct deficiencies by the POC due date.
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
LICENSING EVALUATOR NAME:Jonathan Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2021


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