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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002309
Report Date: 03/08/2024
Date Signed: 03/08/2024 03:49:34 PM

Document Has Been Signed on 03/08/2024 03:49 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SINGH, GITA D.FACILITY NUMBER:
384002309
ADMINISTRATOR:SINGH, GITA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 819-2913
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/08/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Licensee, Gita SinghTIME COMPLETED:
04:05 PM
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On 3/8/2024, at approximately 1:25PM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA was granted entry to the facility by Licensee, Gita Singh. LPA explained the purpose of the visit. Present during the visit were the Licensee, Licensee’s spouse (A1), two helpers (H1 and H2), seven preschool age children, and three infants. The facility is in compliance with capacity requirements on this day. The facility’s hours of operation are 8:00AM to 6:00PM, Monday to Friday.

Daycare Areas: Bedroom #3 (Classroom #1), Living Room #2 (Classroom #2), Bathroom #3 and Backyard.
Off-limits Areas: Entire upper level. Storage room in lower level, and the Garage.

LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. There are age-appropriate toys and learning materials present in Classroom #1 and Classroom #2. There is a combination smoke and carbon monoxide detector present in the home. It was demonstrated to be operational during the visit. The home is equipped with a fully charged 3A40BC fire extinguisher in Classroom #2. All electrical outlets are covered or obstructed by furniture to be inaccessible to children in care. LPA observed cribs to be available for each infant in care. Licensee prepares breakfast, lunch, and snacks for children. Infants bring milk or formula from home, and Licensee prepares it for consumption at the facility. Cots are available for preschool age children. Bedding is brought from home and taken back home once a week to be washed.

At 1:35PM, LPA observed an infant sleeping in an inclined rocking device. LPA informed Licensee that infants need to be moved to a crib or play yard as soon as they fall asleep. Licensee moved the infant to a play yard and removed the inclined rocking device from the daycare areas of the facility. See LIC809-D for deficiency cited and cleared during the visit.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SINGH, GITA D.
FACILITY NUMBER: 384002309
VISIT DATE: 03/08/2024
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At 1:40PM, LPA observed a bassinet present in Classroom #2. It was not in use for napping purposes. LPA advised that Licensee should only use either cribs or play yards for sleeping infants. Licensee understood.

AT 2:00PM, LPA observed an infant to be sleeping with a jacket that had a hood on. LPA informed Licensee of regulation that states that infant’s heads shall not be covered while sleeping. Licensee immediately removed the hood. See LIC9102-TV for technical violation issued today.

LPA observed the outdoor play area in the Backyard to be free of debris and other loose articles. The Backyard is enclosed by a fence. There are two separate play areas for infants and preschool age children. There are age-appropriate toys and equipment for children. There are no pools or other bodies of water present in the facility. All off-limits areas are secured by childproof locks or gates. Per Licensee, there are no firearms stored in the facility.

LPA reviewed facility records and ten children’s files. Licensee’s First Aid/CPR expires 10/2024. Licensee’s Mandated Reporter Training expires 5/2025. All adults working or living in the home have acquired fingerprint clearance and are associated to the facility. All required postings are visible and accessible for review in Classroom #2.

LPA observed children’s files to contain the equivalent of Emergency and Identification Information (LIC700) and Consent for Emergency Medical Treatment (LIC627). Five out of ten children’s files contained Notification of Parents’ Rights (LIC995A). LPA informed Licensee of requirement to maintain signed copies of the form in each child’s file. See LIC9102-TV for technical violation issued today.

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.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SINGH, GITA D.
FACILITY NUMBER: 384002309
VISIT DATE: 03/08/2024
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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 child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
See LIC809-D for deficiencies cited today regarding infant safe sleep. See LIC9102-TV for technical violations issued today regarding infant safe sleep and children's records. Appeal rights were printed and provided to Licensee.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee, Gita Singh.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/08/2024 03:49 PM - It Cannot Be Edited


Created By: Jonathan Tse On 03/08/2024 at 03:16 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SINGH, GITA D.
FACILITY NUMBER: 384002309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

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 by not moving a sleeping infant into a crib or play yard which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2024
Plan of Correction
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Licensee moved the sleeping infant into a play yard upon LPA notifying them of the violation. LPA discussed safe sleep regulations with Licensee. Licensee understood the reasoning behind the regulation and will utilize play yards and cribs for sleeping infants going forward. This deficiency will be cited and cleared the same day of the visit, 3/8/2024.
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:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024


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