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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700236
Report Date: 12/13/2023
Date Signed: 12/13/2023 03:03:01 PM

Document Has Been Signed on 12/13/2023 03:03 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 EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MEHRA, SUMEDHA & TARUNFACILITY NUMBER:
015700236
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
12/13/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensee, Sumedha Mehra & Tarun TIME COMPLETED:
02:30 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
Licensing Program Analyst (LPA) Jyoti Saini arrived at the Facility unannounced to deliver the final findings. Upon arrival, LPA observed Licensee parking the car on the driveway. LPA approached the main door and observed Licensee sitting in the car. LPA rang the doorbell, and the Licensee came out of the vehicle. The provider stated she would open the door for LPA and walked around her backyard door to open the main door. Upon entrance, LPA observed two individuals cleaning the house. The Licensee introduced them as a cleaner and stated that she had to drop her kid's lunch at school; however, she returned halfway since her husband decided to take care of it, who is already nearby the school.The Licensee acknowledged that the cleaners were left alone with the children for a short time. LPA notified the provider about Health and Safety Code Section 1596.871, stating that the individual shall have fingerprint clearance before working, residing, or volunteering in a licensed facility. The provider acknowledges that she understands.

California Code of Regulations, {Title 22, Division 12, Chapter 1, Section 102370(d) is being cited on the attached LIC809-D. THE LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAY'S VISIT WITH THE NOTICE, AND THE LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR THE AB 633 FACT SHEET AND A COPY OF THE ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

An exit interview was conducted with Licensee, Sumedha, Tarun Mehra.

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

The Facility's appeal rights were reviewed and given to the licensee, Sumedha, Tarun Mehra.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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 12/13/2023 03:03 PM - It Cannot Be Edited


Created By: Jyoti Saini On 12/13/2023 at 01:56 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: MEHRA, SUMEDHA & TARUN
FACILITY NUMBER: 015700236

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/14/2023
Section Cited
CCR
102370(d)(1)

1
2
3
4
5
6
7
102370(d)(1)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The Licensee shall re-obtain the Family Child Care orientation and submit the statement of what was learned during the presentation to the LPA.
8
9
10
11
12
13
14
Based on observation, interview, and record review, the Licensee did not comply with the section cited above as the Licensee left the children with the house cleaners ( uncleared fingerprint), which poses an immediate risk to the health, safety, and personal rights of the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023


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