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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700420
Report Date: 03/19/2025
Date Signed: 03/19/2025 03:18:17 PM

Document Has Been Signed on 03/19/2025 03:18 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:AGARWAL, SURBHIFACILITY NUMBER:
015700420
ADMINISTRATOR/
DIRECTOR:		AGARWAL, SURBHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 764-7978
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
03/19/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Surbhi AgarwalTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 03/19/2025 at 1:35PM Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Surbhi Agarwal for an Unannounced Annual/Random Inspection. Present during the inspection was the Licensee, her fingerprint cleared husband, her fingerprint cleared assistant, 3 preschool aged children, and 4 infants. Also residing in the home are the Licensees minor son and daughter. The Licensee's home was toured for a health and safety inspection. The facility operates 8:00AM to 6:00PM, Monday – Friday.

ON LIMITS AREA: Living Room, Kitchen, Dining Area, Hallway to Daycare area, Day care Room (room in the back of the house, Bathroom #1 (attached to day care room), Infant Room (first room to the right of day care hallway), and fenced off area Backyard

OFF LIMITS AREA: Two (2) Bedrooms, Bathroom #2, Master Bedroom/Bathroom, the side of the backyard and Garage. Off limits rooms are made inaccessible by closed doors, gates and visual supervision.

ISOLATION AREA: Infant Room

The facility is a single-story home owned by the Licensee. The inside of the home is observed to have age appropriate materials for the children. During today inspection all toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. There is a fully charged 3A40BC fire extinguisher, working combination monoxide detector/smoke detector, and telephone. The home does not contain a fireplace. Licensee stated that there are no firearms or pets or no one who smokes at the home. LPA did not observe any bodies of water in or around the home.

Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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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: AGARWAL, SURBHI
FACILITY NUMBER: 015700420
VISIT DATE: 03/19/2025
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LPA reviewed 7 children's files and that all were complete. Licensee is in ratio. Licensee has current Pediatric CPR and First Aid that expires 12/2026. Licensee’s Mandated Reporter training is complete and expires 9/10/2026 . Both the Licensees husband and assistant have Mandated Reporter training. Licensee's husband has current Pediatric CPR and First Aid training as well. All required postings are made visible.

There were no deficiencies cited on today's inspection.

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 facility representative 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.

Continued on 809-C

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

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: AGARWAL, SURBHI
FACILITY NUMBER: 015700420
VISIT DATE: 03/19/2025
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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 Surbhi Agarwal, 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 Licensee Surbhi Agarwal.

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

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
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