Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420778
Report Date: 03/20/2019
Date Signed 03/20/2019 03:59:53 PM

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SHARMA, PREETIFACILITY NUMBER:
013420778
ADMINISTRATOR:SHARMA, PREETIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
9253618690
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:14CENSUS: 14DATE:
03/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Preeti SharmaTIME COMPLETED:
04:20 PM
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On 3/20/19, Licensing Program Analyst (LPA) Simerjit Kaur, met with licensee Preeti Sharma for an UNANNOUNCED ANNUAL RANDOM INSPECTION. The home was toured for Health and Safety Inspection. Present for this inspection is licensee's fingerprint cleared and associated assistant Pallavi Gaonkar, minor daughter, 1 infant, and 1 school age, 11 preschool age children in care.

The home is double story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are first level: the family room, living room, dining room, kitchen, day care room located next to main entrance, bathroom, and backyard. The OFF LIMIT AREAS are second level: master bedroom/bathroom, 2 bedrooms, 1 bathroom and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the family room. The BACKYARD play area is fenced. It was observed that there are no toxins or hazardous items accessible during the inspection. During the inspection, it was also observed there are no pools, hot tubs or any bodies of water on premises.

The home has a fully charged with 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee and her assistant's CPR and First Aid certificate is current and expires 07/07/2020. Licensee and her assistant are in compliance with the immunization law which pertains to day care providers. The fireplace is screened to prevent access by children. Licensee has waiver for fire place. Per licensee, there are no firearms in the home. The last documented fire and disaster drill was conducted on 01/30/19. Licensee met the Mandated Reporter Training requirement on 7/10/18. Licensee's assistant met the Mandated Reporter Training requirement on 7/9/18
See 809-C
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 292-7241
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2019
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SHARMA, PREETI
FACILITY NUMBER: 013420778
VISIT DATE: 03/20/2019
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Required licensing documents are posted. Per licensee, there are no children on any type of prescription medications. Children files (5) were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. Safe sleep regulation information was provided.

California Law requires Family Child Care Home licensees to Report Unusual incidents or injuries to children in care to the child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Do not leave an Unusual Incident Report on the Licensing Program Analyst voice mail.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.



Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

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

No deficiency cited today. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 292-7241
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2019
LIC809 (FAS) - (06/04)
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