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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700036
Report Date: 05/04/2022
Date Signed: 05/04/2022 04:29:18 PM

Document Has Been Signed on 05/04/2022 04:29 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: 16CENSUS: 11DATE:
05/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kamalpreet KaurTIME COMPLETED:
04:40 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 5/4/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived to the facility unannounced for an unrelated matter. LPA was met by Licensee, Kamalpreet Kaur, and one fingerprint cleared and associated assistant. Present for today's visit were 11 children in care (four infants and seven preschoolers).

During today's visit, LPA observed one infant, C1, asleep in a crib with a loose-fitted sheet and a blanket inside the crib. Assistant immediately removed the blanket from the crib and replaced the loose sheet with a tight fitted sheet. Two Type B deficiencies were cited. See LIC809-D for citation details.

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.

Exit interview conducted. Appeal Rights provided. Notice of site visit given.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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 2
Document Has Been Signed on 05/04/2022 04:29 PM - It Cannot Be Edited


Created By: Jonathan Williams On 05/04/2022 at 04:03 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: 05/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2022
Section Cited
CCR
102425(a)(3)

1
2
3
4
5
6
7
Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Assistant immediately removed the loose fitting mattress and replaced it with a tight fitting mattress.
8
9
10
11
12
13
14
Based on LPA observation, an infant in care was observed to be placed to sleep in a crib with a loose fitted sheet. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
05/04/2022
Section Cited
CCR102425(b)

1
2
3
4
5
6
7
Cribs or play yards shall be free from all loose articles and objects.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Assistant removed the blanket from the crib immediately.
8
9
10
11
12
13
14
Based on LPA observation, an infant in care was placed to sleep in a crib with a blanket inside the crib. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
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: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2