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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700116
Report Date: 10/11/2022
Date Signed: 10/11/2022 01:40:52 PM

Document Has Been Signed on 10/11/2022 01:40 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: 8CENSUS: 0DATE:
10/11/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:09 PM
MET WITH:SANDHYA GUPTATIME COMPLETED:
02:18 PM
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On Oct 11, 2022 Licensing Program Analyst (LPA) Cortez conducted a case management visit for a capacity increase inspection. Present in the home today was the licensee Sandhya Gupta and her fingerprint and TB cleared husband Sunil Gupta, and one pre-school age child. All requested documents were received for the increase of capacity application. The fire clearance for a capacity of 14 was received from the Hayward Fire Department.

Ratios were discussed including proper ratio compliance in case an assistant is unavailable for a day and or does not come due to illness etc. The Licensee was reminded that whenever an assistant is not present, the licensee will comply with the capacity requirements.

The home was toured and inspected for health and safety.The home is one story, which consists of 4 bedrooms, 2 bathrooms, kitchen, living room, activity area(daycare), and backyard/Outdoor play area) and garage.
On Limit areas are the activity area, living room and the (1) bedroom (right hand side from the entrance) ,1 bathrooms (left side), and backyard (play area).The off limit areas will be the 3 bedrooms, kitchen, 1 bath(master), garage. The isolation area will be the on limit 1 bedroom room.

There are no deficiencies cited on this visit.


The home is recommended for a Large Family Child Care Home License effective today, 10/11/2022.

Exit interview conducted and report was reviewed with the Licensee.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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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