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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700143
Report Date: 06/26/2024
Date Signed: 06/26/2024 12:27:59 PM

Document Has Been Signed on 06/26/2024 12:27 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HASSAN GURUPRASAD, JYOTHIFACILITY NUMBER:
015700143
ADMINISTRATOR/
DIRECTOR:		HASSAN GURUPRASAD, JYOTHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 784-2623
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Jyothi Hassan GuruprasadTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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On 6/26/2024 at 9:40PM Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Jyothi Hassan Guruprasad for an Unannounced Annual/Random visit. Present during the inspection was the Licensee, her adult helper, four infants, and 5 preschool age children. Licensee lives in the home with her husband and minor daughter. The facility operates from 8:15AM – 6:00PM, Monday - Friday.

ON LIMITS AREA: Living Room, Sun Room, 1st Bedroom on the right side of the hallway, Hallway Bathroom, and Backyard
OFF LIMITS AREA: Kitchen, Master Bedroom and Bathroom, Second Bedroom, Garage, and Detached Room in the Backyard
ISOLATION AREA: On-Limit Bedroom

The facility is a single-story home owned by the Licensee. The inside of the home is observed to be neat, clean with age-appropriate materials for the children. During today's visit all toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms and no pets in the home.

The home has a fully charged 2A10BC fire extinguisher. The home has a working carbon monoxide detector and smoke detector. All napping equipment is clean, free from defects and properly maintained. Licensee provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. The fireplace in the living room is locked making it inaccessible to the children in care. Licensee stated that she does not transport children.
Continued 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HASSAN GURUPRASAD, JYOTHI
FACILITY NUMBER: 015700143
VISIT DATE: 06/26/2024
NARRATIVE
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The backyard is fully fenced with age-appropriate materials for the children. Licensee uses the side gate leading to the backyard as the day care entrance. There is a detached structure on the right side of the backyard that, per the homes fire clearance, is not to be used by the children in care. Licensee states that the room is used outside of operating hours and for storing the outside materials.

LPA reviewed 10 children's files. The 2 infants under 12 months are missing the infant sleep plan (LIC9227) in their files. All infant files did not have sleep logs completed. At 10:30AM a fifth infant was dropped off putting the home out of ratio. Licensee called one infants parent to them pick up to put the facility back in ratio. Licensee's assistants file was complete. Licensee’s Health and Safety training with Lead Poisoning component has been completed and Pediatric CPR and First Aid training is completed and expires 4/20/2026. Licensee’s Mandated Reporter training is complete and expires 5/15/2025. All required forms are posted and visible for public view in the sun room by the entrance door. Fire drill log is complete with the last drill logged 2/20/2024. All adults living and working in the home have obtained a criminal record clearance.

There was three deficiencies cited on today's visit. See 809-D for deficiencies.

LPA Jackson informed Facility Representative that this report dated 6/26/2024 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Jackson informed the Facility Representative that the licensee to provide a copy of this licensing report dated 6/26/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HASSAN GURUPRASAD, JYOTHI
FACILITY NUMBER: 015700143
VISIT DATE: 06/26/2024
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Jyothi Hassan Guruprasad, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee Jyothi Hassan Guruprasad.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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Document Has Been Signed on 06/26/2024 12:27 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 06/26/2024 at 11:40 AM
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: HASSAN GURUPRASAD, JYOTHI
FACILITY NUMBER: 015700143

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(1)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation record review, the licensee did not comply with the section cited above in 5 infants were present putting the facility out of ratio which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/27/2024
Plan of Correction
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The Licensee immediately called one of the infants parents to pick them up to put the facility back into ratio. Licensee will disenroll one infant and LPA will conduct a POC visit to verify.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jason Jang
LICENSING EVALUATOR NAME:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024


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Document Has Been Signed on 06/26/2024 12:27 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 06/26/2024 at 11:40 AM
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: HASSAN GURUPRASAD, JYOTHI
FACILITY NUMBER: 015700143

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

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 in all infants present did not have sleep logs completed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2024
Plan of Correction
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Licensee will complete 1 week of sleep logs for all infants and submit proof to LPA by email by POC date.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

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 in 2 infants under 12 months do no have a LIC9227 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2024
Plan of Correction
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Licensee will have the parents complete the LIC9227 for the 2 infants and send proof to LPA by POC date by email.
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:Jason Jang
LICENSING EVALUATOR NAME:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024


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