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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700245
Report Date: 11/29/2022
Date Signed: 11/29/2022 11:20:24 AM

Document Has Been Signed on 11/29/2022 11:20 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:GUPTA, ADITIFACILITY NUMBER:
075700245
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Aditi GuptaTIME COMPLETED:
11:30 AM
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On November 29, 2022 at 9:00am, Licensing Program Analyst (LPA) Julia Placencia arrived announced for a Prelicensing Inspection. LPA met with applicant Aditi Gupta and her husband Piyush Gupta. Also residing in the home are the applicant’s two children (8 and 10 year old daughters). The home was toured with the applicant and her husband to conduct a health and safety inspection. Applicant states the hours of operation for day care will be Monday through Friday, 8:30am to 5:00pm.

The home is Tri-level which consists of a family room, bedroom and bathroom on the lower level; kitchen, dining room and living room on the main level; three bedrooms and two bathrooms on the upper level. There is also a garage and backyard with a locked storage shed. The home is neat and clean with heating and ventilation for safety and comfort.

ON LIMITS: Entire lower level; backyard. The isolation area will be in the family room away from children.

OFF LIMITS: Entire mid and upper levels, storage shed in backyard and garage. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits.

The outdoor play area will be the backyard, which has a fence surrounding the perimeter of yard. Parents will drop off children by entering through the left side gate. There are no pools, hot tubs or any other bodies of water. There are ample age appropriate toys, which were observed to be safe, clean and in good repair. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 2A10BC fire extinguisher which is located in the garage, working smoke detector and carbon monoxide detector on the lower level wall near bathroom. There is also a fully stocked first aid kit and telephone. The fireplace is screened and secured with straps. Heater vents are located on the walls near the ceiling. Per applicant, there are no firearms in the home. ***Continued on LIC 809C...
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GUPTA, ADITI
FACILITY NUMBER: 075700245
VISIT DATE: 11/29/2022
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The applicant’s health and safety training has been completed, and includes the child nutrition and lead poisoning components. First Aid/CPR certificate is current, expiring on 8/19/24. A copy of the lease agreement has been reviewed and shows control of property. The applicant has provided proof of the required immunizations for daycare providers, and mandated reporter training was completed on 10/10/22. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed, and copies were left with the applicant.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

Applicant was reminded that all adults 18 and over living or working in the home, 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.

Applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.



LPA discussed the safe sleep regulations with applicant 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 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.

***Continued on LIC 809C...

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
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: GUPTA, ADITI
FACILITY NUMBER: 075700245
VISIT DATE: 11/29/2022
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The following corrections are required before the home can be licensed:
  • Install a child proof gate at bottom of stairs in family room.
  • Install barrier to keep children away from sprinkler system.
  • Install barrier to keep children away from rose bushes in backyard.
  • Install barrier to keep children away from the left side fence near vegetable garden, or repair fence.

These corrections shall be submitted by providing pictures within 14 days of this report. LPA may visit facility to confirm corrections have been complete. This report shall remain on file for 3 years.

Exit interview conducted with applicant Aditi Gupta and copy of report provided.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained. A fire/disaster drill must completed at least every six months and must be documented. Mandated reporter requirements also discussed. Applicant received copies of various pamphlets pertaining to child's safety and parent's responsibilities. Informed the applicant that all forms can be downloaded at www.ccld.ca.gov
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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