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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700300
Report Date: 06/18/2024
Date Signed: 06/18/2024 03:43:17 PM

Document Has Been Signed on 06/18/2024 03:43 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:SINGH, KIRANFACILITY NUMBER:
015700300
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 8DATE:
06/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Kiran Singh TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 6/18/2024 at 12:40PM Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Kiran Singh for an Annual/Random visit. Present during the inspection was the Licensee, her husband, 3 preschool aged children, 3 infants, 6 year old son , her minor daughter and one child who's age could not be determined during today's visit. LPA informed Licensee that she is out of ratio. When more than 6 children are present only 2 can be infants. One child was picked up during the visit. Licensee lives in the home with her husband, and their two minor children. Licensee’s home was toured for a health and safety inspection. The facility operates from 8:30AM – 6:00PM, Monday - Friday.

ON LIMITS AREA: 1st Bedroom on the right side of the hallway (Playroom), 2nd Bedroom on the right side of the hallway (Napping Room), Hallway Bathroom, Back Patio and Backyard
OFF LIMITS AREA: Living Room, Dining Area, Kitchen, Master Bedroom and Bathroom, Two (2) Bedrooms (at the end of the hallway) and Garage
ISOLATION AREA: Napping Room

The facility is a single-story home owned by the Licensee. The inside of the home was observed to have age-appropriate materials for the children. During today's visit all toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. All off-limit areas are made inaccessible with gates and locks. Licensee provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. Licensee stated that they do not transport children. There are no pets and no firearms in the home.

Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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: SINGH, KIRAN
FACILITY NUMBER: 015700300
VISIT DATE: 06/18/2024
NARRATIVE
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The home has a fully charged 2A10BC fire extinguisher on the back patio. There is a working combination smoke/carbon monoxide detector in the home. The home is equipped with central heat and air for proper ventilation. LPA observed 3 infants with blankets with them inside their pack and plays. LPA informed Licensee that infant safe sleep states that cribs and play yards are to be free of all loose items including blankets. The backyard is fully fenced and well maintained with age-appropriate materials for the children. LPA did not observe any bodies of water in or around the home that could be a potential danger to the children in care.

LPA reviewed 6 children's files and 4 out of the 6 files were missing the immunization's. One child did not have a file to provide to LPA. Licensee was able to have 3 parents send their children's immunization's during today's visit. LPA reminded Licensee that all immunization records are to be provided prior to enrollment. Licensee’s Health and Safety training with lead poisoning component has been completed. Licensee’s Pediatric CPR and First Aid training's are completed and expires 3/4/2025. Licensee’s Mandated Reporter certificate is complete and expires 6/12/2026. All adults living in the home have obtained a criminal record clearance. All required forms are posted and visible for public view in the hallway by the door leading to the backyard.

LPA Jackson informed licensee Kiran Singh that this report dated 6/18/2024 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 licensee to provide a copy of this licensing report dated 6/18/2024 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.

There were 3 deficiencies cited on today's visit. See 809-D for deficiencies.

Continued 809-C

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

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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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: SINGH, KIRAN
FACILITY NUMBER: 015700300
VISIT DATE: 06/18/2024
NARRATIVE
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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.

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 Kiran Singh, 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 Kiran Singh.

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

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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Document Has Been Signed on 06/18/2024 03:43 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 06/18/2024 at 02:50 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: SINGH, KIRAN
FACILITY NUMBER: 015700300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(3)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in
Section 1597.44 of the Health and Safety Code are met.

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 at least 3 infants were present in the home with more than 6 children which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2024
Plan of Correction
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Licensee will temporarily disenroll one infant from the day care until the second birthday of another child. Proof of disenrollment must be submitted to LPA by POC date 6/19/2024. POC visit to follow up as well.
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: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024


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Document Has Been Signed on 06/18/2024 03:43 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 06/18/2024 at 02:50 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: SINGH, KIRAN
FACILITY NUMBER: 015700300

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 3 sleeping infants had blankets with them in the play yards which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/25/2024
Plan of Correction
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Licensee will review the safe sleep regulations provided by the LPA. After review Licensee will submit a written and signed and dated statement that she understands the safe sleep regulations. Licensee will submit the statement to LPA by email by the POC date 6/25/2024.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

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 4 out of 6 children did not have immunization records in their files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2024
Plan of Correction
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Licensee will obtain the 1 remaining immunizations from the parents to put in file. Licencee will submit proof to LPA by POC date 6/25/2024.
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: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024


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