<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421071
Report Date: 04/27/2022
Date Signed: 04/27/2022 02:09:15 PM

Document Has Been Signed on 04/27/2022 02:09 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:NAGAR, ALPAFACILITY NUMBER:
013421071
ADMINISTRATOR:NAGAR, ALPAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 425-0061
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
04/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Alpa NagarTIME COMPLETED:
02:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On April 27, 2022 Licensing Program Analyst (LPA) Lorraine Dacanay Breaux arrived a the home, no response to the door. LPA Breaux had to telephone licensee. Licensee was in the rear yard with the children. LPA Breaux met with licensee Alpa Nagar for the purpose of conducting an unannounced 1 year required annual inspection. Present in the home for today’s inspection was the licensee, husband, 3 children were in care. The hours of operation will be Monday - Friday, 8:30 AM to 5:30 PM. Child care is in ratio today.

This is a two story home, 4 bedrooms and three bathrooms. On limits area consist of the family room, living room, kitchen (added during today's inspection per licensee request) bathroom on first floor in hallway (across from the garage). Off Limits: The entire second floor is off limits, all upstairs bedrooms, including master bedroom/bathroom, the bedroom located on the first floor, garage, and front and rear yard. Per the licensee, the ISOLATION AREA will be in the on limits family room away from the other children in care. LPA Breaux took the rear yard off limits as of today, April 27, 2022, the area is not safe for children to play. At a later date, LPA will return to re-inspect the rear yard area for safety. Off limits area is made inaccessible by use of gates, closed doors and visual supervision. The fireplace is located in the family room and is blocked with glass door and safety lock. The home has heating and ventilation for safety and comfort.

Per licensee, there are no firearm in the home. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children. Old paint was observed in side of rear yard near gated (remove) Stairs are gated. Licensee has ample age-appropriate toys and learning materials inside. The home has a fully charged 2A10BC fire extinguisher. Smoke detector, carbon monoxide detector and a working telephone. The home has an approved fire clearance for up to 14 children dated 11/4/19. Fire inspector indicates that children are not permitted on the second floor or garage.

LPA reminded licensee of the following: Mandated Reporter training is to be renewed every two years; CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: NAGAR, ALPA
FACILITY NUMBER: 013421071
VISIT DATE: 04/27/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA requested and reviewed the files of three (3) children in care. All files contained Immunization, Parent's Rights, and Medical Consent forms. The facility roster was reviewed, and copies were obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on April 18, 2022. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires 03/12/2023. The licensee has completed mandated reporter training and the certificate expires 03/15/24. The licensee is in ratio today. All required forms are posted and visible for public review.

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 and fire/disaster drill every six months must be documented.

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.

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.

The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: NAGAR, ALPA
FACILITY NUMBER: 013421071
VISIT DATE: 04/27/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee [or facility representative] 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.

At approximately 11:00 AM the following deficiencies were observed during the inspection:

- The complete rear of the yard is not level near the rear fence, there is a drop about 3-4 feet. LPA advised the licensee to fence and/or add several large safety hazard cones.
-The outdoor play area has broken/unclean toys/play structures, table, pots, old paint cans.
-There is a gap between the wood on the deck with exposed nails, large enough for a child's foot to fit through (repair/replace)
-There is a built in barbecue pit in the backyard. There is an opening under the barbecue which is large enough for a child to get in. In addition, there is a space behind that barbecue pit with broken pots, glass, trash cans, etc (all items must be removed)
- The rear deck has loose and unstable wooden floor boards (repair/replace)
-LPA Breaux observed standing water in the fountain, there is a mesh fence that is not secure on both sides, some of the plant are sharp (rose bushes) and a potential safety risk for children.

Due to the above deficiencies, LPA Breaux has removed the rear yard from on limits to OFF LIMITS. This area is not to be used until LPA re-inspects.

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.

The attached type A deficiency is cited today. Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgment of Receipt of Licensing Reports which is to be placed in each child’s file.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Alpa Nagar.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/27/2022 02:09 PM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 04/27/2022 at 01:52 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: NAGAR, ALPA
FACILITY NUMBER: 013421071

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(5)
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: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview , the licensee did not comply with the section cited above in five out of 5 (five) objectsand identifiers which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2022
Plan of Correction
1
2
3
4
Licensee will add hazard cones and/or fence near the rear of the yard and around the water fountain. Remove any water from the fountain (add dirt/rocks/etc). Remove all debris through out the rear yard such as: broken/sharp items/toys, plant, plant pots, trash containers, paint cans, etc. ANYTHING that will pose a hazard to children in care. Clean play equipment and remove spider webs.
Licensee will repair/replace deck wood boards as needed.
Licensee will add a safety gate on side of the house. Licensee will get a cover for the barbaque pit with lock to prevent access. Licensee will understands and will not use the rear yard until reinspection.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Chandra Charles
LICENSING EVALUATOR NAME:Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022


LIC809 (FAS) - (06/04)
Page: 4 of 4