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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700116
Report Date: 06/30/2021
Date Signed: 06/30/2021 01:33:30 PM

Document Has Been Signed on 06/30/2021 01:33 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:GUPTA, SANDHYAFACILITY NUMBER:
015700116
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
06/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sandhya GuptaTIME COMPLETED:
03:15 PM
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On June 30, 2021, Licensing Program Analyst Sidney Cortez, met with licensee SANDHYA GUPTA for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee SANDHYA GUPTA, the home was toured to conduct a Health and Safety Inspection. Currently not fully operational, and have no children in care. Currently no operational due to covid health concerns.

This is a one-story home which consists of a living room/dining room, four bedrooms, a hallway bathroom, master bath, kitchen, family room, attached garage, and backyard. The home is neat and clean, with central heating and air conditioning. The ISOLATION AREA will be the bedroom first one to the right of the hallway.


The Off-Limit areas 3 bedrooms, family room, kitchen and garage. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during today's tele-inspection. Per licensee, there are no firearms in the home.
On-limit-areas include: Living room/dining room (which was converted into a children’s playroom), family room and hall bathroom. There are ample age appropriate toys, learning materials, and equipment that appear to be safe and in good condition. The home has a working smoke detectors, carbon monoxide detector, and First Aid Kit.There are ample age appropriate toys that are safe and observed to be clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPAs did not observe any hazardous materials or toxins accessible to children today.

The home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (Dec 14. 2021). The licensee's mandated reporter training is complete and will expire in (Feb 2023) . Licensee will complete it this week. (STATE IF LICENSEE IS IN COMPLIANCE WITH THE NEW IMMUNIZATION LAW) Per licensee, there are no firearms in the home. The licensee have not conducted fire and disaster since they have been non operational since Prelicensing of May 2020.0 Children files were reviewed (no children present/non operational at the moment), facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2021
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GUPTA, SANDHYA
FACILITY NUMBER: 015700116
VISIT DATE: 06/30/2021
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LPA Cortez provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licenseeLPA Cortez provided licensee with a copy of the CDSS handout on Effects of Lead Exposure and Never Shake a Baby Brochure (attached PUB 271)The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.California Law requires Family Child Care Home licensees 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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.


Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov




For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list




This entire report has been read to the Licensee by LPA Cortez. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Cortez or CCLD.




There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
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