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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700300
Report Date: 06/10/2022
Date Signed: 06/10/2022 11:01:28 AM

Document Has Been Signed on 06/10/2022 11:01 AM - 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:SINGH, KIRANFACILITY NUMBER:
015700300
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kiran Singh TIME COMPLETED:
11:10 AM
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On 06/10/2022, at 9:00AM Licensing Program Analyst Kelly Phan, met with applicant Kiran Singh and her fingerprinted and associated husband for an announced pre licensing visit to conduct a health and safety inspection. Presented during today's inspection was the applicant, applicant's husband, and their two young children between the ages of 8 1/2 and 4 years old. Hours of operation will be Monday to Friday between 8:30AM to 6PM.

The applicant's home is a one story home that is neat and clean with heating and ventilation to provide safety and comfort . At 9:15AM, LPA observed that the applicant does not have the recommended fire extinguisher of 2A10BC or larger; applicant states that they would order the correct size of fire extinguisher and send a picture to LPA. However, applicant was able to purchase one today and is complying with the recommended fire safety standards. There are working carbon monoxide and smoke detectors along with a telephone at the facility. LPA reviewed a mortgage statement that shows applicant owns the property. The areas of the day care will consist of bedroom #1 which would be the play room (closest by the garage), bedroom #2 (sleeping room for children and isolation area), gated backyard, and hallway bathroom (across from the playroom). The "OFF LIMIT" areas are kitchen, living room, dining room, bedroom #3 (applicant's master bedroom), bathroom #2 (master bathroom), bedroom #4 (one of the children's bedroom), and bedroom #5 (office space), left and right side of the backyard. OFF LIMIT areas has a barrier/gate to prevent access to those areas. The home has a fireplace, however it is screened with a glass door and per applicant's husband it is only used occasionally. At 9:30am, the backyard play area was observed and is free from defects or dangerous conditions. There are age appropriate new toys for the children to utilize. There are no pools, hot tubs or any other bodies of water on the premises. Per licensee, there are no pets or firearm present at the home. All hazardous materials and toxins are out of the reach of children by installing child safety locks on the cabinets and drawers.

SEE LIC 809 C


SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2022
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 3
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: SINGH, KIRAN
FACILITY NUMBER: 015700300
VISIT DATE: 06/10/2022
NARRATIVE
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At 10:00am, LPA reviewed that the applicant's preventive health and safety training are completed, CPR and First Aid certificates are current and will expire on 02/13/2023. Applicant have completed the Mandated Reporter training on 02/06/2022 and have required immunizations on file. LPA reviewed with applicant and applicant's husband the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, information to be posted, and along with immunization records.

Exit interview conducted and report was reviewed with licensee Kiran Singh. Appeal rights were also provided


The facility is recommended for licensure as of today, 06/10/2022. This report must be kept for 3 years.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. This facility does not provides IMS to children in care. 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: http://www.ada.gov/childqanda.htm.”

SEE LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
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: SINGH, KIRAN
FACILITY NUMBER: 015700300
VISIT DATE: 06/10/2022
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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/APPLICANT 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC809 (FAS) - (06/04)
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