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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422758
Report Date: 11/04/2022
Date Signed: 11/04/2022 12:13:50 PM

Document Has Been Signed on 11/04/2022 12:13 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:TRIPATHI, ANJUFACILITY NUMBER:
013422758
ADMINISTRATOR:TRIPATHI, ANJUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 666-6320
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
11/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Anju TriathiTIME COMPLETED:
12:20 PM
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On November 4th, 2022 at 9:45 am, Licensing Program Analyst (LPA) April Wright met with licensee Anju Tripathi for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during inspection were 6 children and fingerprint cleared spouse Shailendra Tripathi and Assistant Nusratbibi Khan. Hours of operation are 8:00am - 6:00pm Monday through Friday.

LPA toured the facility to conduct a health and safety inspection. The single story home was clean and orderly, with heating and ventilation for safety and comfort of children in care. The isolation area is the kids bedroom (#3 and #4) which is a section away from other children in care.

On limit areas include: Day-care children's room (next to prayer room), hallway bathroom, first bedroom to the right in hallway, front patio and side yard.
Off-limits areas include: Kitchen, Living Room, master bedroom and bathroom and garage

Licensee informed LPA that new grass play area (side yard) with structure is available for use and would like to be placed in on limits area. LPA performed inspection on the play area and informed Licensee that suitable and safe for use. LPA informed Licensee to send updated facility sketch to licensing to reflect change.

The off limits are and will be made inaccessible by closed and/or locked doors and visual supervision. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today’s inspection. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. There are ample age appropriate toys that appear to be safe and in good condition.


See LIC809 -C for continuance
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: TRIPATHI, ANJU
FACILITY NUMBER: 013422758
VISIT DATE: 11/04/2022
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The home has a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fully stock First Aid Kit. and telephone. There is a fireplace in the living room that has glass doors with child lock that is inaccessible to children in care. Per licensee there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers.

LPA requested and reviewed the files of 6 children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 9/7/2022. The licensee has a current CPR/First aid certificate which expires on 9/2024. Mandated Reporter Training was not completed by Licensee. The licensee is in ratio today. All required forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. No IMS PROVIDED AT THIS FACILITY. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

California Law requires Child Care Centers 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 624). 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. The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

LPA discussed the Safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep web page 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.


See LIC 809C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: TRIPATHI, ANJU
FACILITY NUMBER: 013422758
VISIT DATE: 11/04/2022
NARRATIVE
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Licensee was reminded that all adults 18 and over, 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 childcare center. 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.

Violations Cited Today:

· Technical Violation - Licensee did not fully complete Mandated Reporter Training course online



A notice of site visit was given and must remain posted 30 days. Exit interview conducted and report was reviewed with Anju Tripathi.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
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