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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415463
Report Date: 06/26/2024
Date Signed: 06/26/2024 04:58:36 PM

Document Has Been Signed on 06/26/2024 04:58 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GUPTA, RENUKAFACILITY NUMBER:
434415463
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
06/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:37 PM
MET WITH:Renuka GuptaTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced annual/random inspection. LPA met with Licensee Renuka Gupta and explained the reason for the inspection. Present during today's inspection were Licensee, her spouse, her adult child, and six children. Facility was within ratio during today's inspection.

LPA observed that license was posted. LPA reminded Licensee that the Notification of Parent's Rights needs to be posted. The hours of operation are Monday through Friday 9AM to 6PM.

LPA toured the inside and outside of the home. The off-limit areas of the home are master bedroom and garage. Upon arrival to the home at 12:38PM, LPA observed that children were in the garage. LPA discussed with Licensee that she needs to notify Licensing if she wants to change any off-limits areas to on-limit and get approval from Licensing prior to using it. LPA discussed with Licensee about ensuring that all off-limit areas are not accessible to children. The home was observed to be clean. There is an electronic fireplace. LPA discussed with Licensee that anything that states to keep out of reach of children needs to be inaccessible. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as a firearms, stored in the home.

The backyard is used and is fenced. There is a climbing dome in the backyard, which was not anchored to the ground. LPA discussed with Licensee that any climbing structure needs to be anchored to the ground. There were no bodies of water observed during today's inspection. LPA observed that there was a shed on the left side of the yard, which had tools, paint, and other chemicals, and was not locked.
-------------------continues on 809 dated 06/26/2024 page 2-----------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUPTA, RENUKA
FACILITY NUMBER: 434415463
VISIT DATE: 06/26/2024
NARRATIVE
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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-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 does not transport children, but understands that children cannot be left alone and unattended in parked vehicles.

A copy of the facility roster was obtained. Five children's files were reviewed during today's inspection. The records reviewed include but not limited to parent's rights. LPA discussed with Licensee about maintaining documentation verifying the child’s enrollment and attendance at kindergarten.

Licensee completed the Mandated Reporter training on 12/04/2022. Licensee was reminded that Mandated Reporter training requires renewal every two years. Licensee has an email dated 01/17/2023 that she completed CPR/First Aid, but does not have her certificate. Licensee immunization records for measles and pertussis are on file.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GUPTA, RENUKA
FACILITY NUMBER: 434415463
VISIT DATE: 06/26/2024
NARRATIVE
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The adults 18 and over living in the home are Licensee, her spouse, and her adult child. Licensee also has one minor child. All adults have cleared criminal record and child abuse index clearance. 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.

During the exit interview, the LICENSEE Renuka, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee will submit the following by 07/15/2024:
- proof that climbing dome removed
- CPR/1st Aid certificate

As a result of this inspection, Type A and Type B citations were issued. Exit interview conducted and report was reviewed with Licensee Renuka Gupta. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed Licensee, Renuka Gupta, that this report dated 06/26/2024 documents two Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Licensee, Renuka Gupta, to provide a copy of this licensing report dated 06/26/2024 that documents any Type A citation(s) 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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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Document Has Been Signed on 06/26/2024 04:58 PM - It Cannot Be Edited


Created By: Samantha Yip On 06/26/2024 at 02:25 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GUPTA, RENUKA
FACILITY NUMBER: 434415463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

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, which poses an immediate health, safety or personal rights risk to persons in care. LPA observed that there was a shed on the left side of the yard that was not locked, which had tools, paint, and chemicals.
POC Due Date: 06/27/2024
Plan of Correction
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Deficiency corrected during today's inspection. Licensee's spouse put a lock on the shed.
Type A
Section Cited
CCR
102416.3(a)(1)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (1) Conversion of a garage (either attached or detached) into a "child care" room.

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, which poses an immediate health, safety or personal rights risk to persons in care. Upon arrival to the home, LPA observed that there were children inside the garage.
POC Due Date: 06/26/2024
Plan of Correction
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Effective today, 06/26/2024, Licensee will cease using the garage and understands that children cannot be in the garage.
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/26/2024 04:58 PM - It Cannot Be Edited


Created By: Samantha Yip On 06/26/2024 at 02:25 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GUPTA, RENUKA
FACILITY NUMBER: 434415463

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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, which poses a potential health, safety or personal rights risk to persons in care. Licensee has an email dated 01/17/2023 from American Red Cross that she completed course.
POC Due Date: 07/15/2024
Plan of Correction
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By POC 07/15/2024, Licensee will submit CPR/1st Aid card to Licensing.
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024


LIC809 (FAS) - (06/04)
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