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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010208682
Report Date: 07/26/2023
Date Signed: 07/26/2023 05:05:07 PM

Document Has Been Signed on 07/26/2023 05:05 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SINGH, PURNIMAFACILITY NUMBER:
010208682
ADMINISTRATOR:SINGH, PURNIMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 843-5612
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:44 PM
MET WITH:Purnima SinghTIME COMPLETED:
05:13 PM
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On July 26, 2023 at 3:44pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Purnima Singh for the purpose of conducting an unannounced 1-year annual inspection. Only the Licensee was present for today's inspection.Operating days and times are Friday through Sunday from 3pm-11:30pm.

The home is single family home with four bedrooms and three bathrooms, a living room, kitchen,and a family room.

On Limit Areas - living room, kitchen, bedroom next to the kitchen, family room and the bathroom past the kitchen.
Off Limit Areas - the two bedrooms and one bathroom upstairs, the single bedroom and bathroom downstairs, and the backyard which will be blocked by locked doors, a safety gate, and visual supervision. There are no pools, hot tubs or any other bodies of water during today's inspection.
ISOLATION AREA will be the couch in the living room.

The home has a fully charged 2A10BC fire extinguisher, a working smoke detector, and a working carbon monoxide detector in the bedroom past the kitchen. The Licensee has a working telephone. Per Licensee, there are no firearms in the home. The Licensee has a current CPR/First Aid certificate which expires on February 2025. The Licensee has a current Mandated Reporter Certificate which expires on April 12, 2025. The home has heating and ventilation for safety and comfort. Licensee has ample age-appropriate toys and learning materials in the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection. LPA reviewed children's and Staff files which were found to be complete. There is a fireplace in the home which is blocked to prevent access by the children. Per the Licensee, there are no firearms in the home. The Licensee provides dinner in the event that the children are not provided food from home.
**********************************Report Continues on LIC 809-C*******************************
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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: SINGH, PURNIMA
FACILITY NUMBER: 010208682
VISIT DATE: 07/26/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. 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

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-and-resources/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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

During the Exit Interview, Licensee Singh confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There were no deficiencies cited during today's visit.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with Licensee Purnima Singh.
Report and Appeal Rights were provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC809 (FAS) - (06/04)
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