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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422758
Report Date: 02/15/2024
Date Signed: 02/15/2024 12:34:26 PM

Document Has Been Signed on 02/15/2024 12:34 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: 4DATE:
02/15/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Anju TripathiTIME COMPLETED:
12:45 PM
NARRATIVE
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On February 15th, 2024 at approximately 11:00am Licensing Program Manager Chandra Charles and Licensing Program Analyst April Wright, met with Licensee Anju Tripathi at the Oakland Southeast Regional office for an Informal Conference meeting. Present during this meeting was licensee husband Shailendra Tripathi. The purpose of this informal meeting was to discuss and present the complaint findings of a complaint investigation as well as operations of the family child care home.

On October 10, 2023, a complaint was filed against the Licensee Family Child Care Home (FCCH) license. A minor child sustained unexplained injuries while in care. Based on the investigation conducted by Community Care Licensing Department (CCLD) Investigation Bureau it was determined the allegation of Personal Rights was substantiated. The investigation revealed the licensee left her FCCH during the day-care hours and left the day-care children in care of her assistant and her husband.

During the absence of the licensee from the FCCH a child’s Personal Right’s was violated.

The licensee is being cited today under the Title 22 regulation 102423(2) which states: a child is to receive safe, healthful, and comfortable accommodations, furnishings, and equipment. The minor child in question was not afforded a safe and healthful accommodations. Because of the serious nature of the child’s injuries a type ‘A’ citation is being issued and civil penalty of $500.00. Due to lack of supervision with regards to the child. The licensee is being placed on required site inspection.

During the general conversation, tips were provided to the licensee of how to conduct wellness checks of children enrolled in their facility. Wellness check should be conducted once the child arrives at the facility for care.

See LIC809C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: TRIPATHI, ANJU
FACILITY NUMBER: 013422758
VISIT DATE: 02/15/2024
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The Plan of Correction for the deficiency cited is for the licensee today:

· View the Child Care Videos for Providers: (1.) Supervising Children in family childcare and (2.) Children’s Personal Rights in childcare.

· Write a page stating what the videos were and your understanding of these videos as pertaining to License Daycare Providers.

· Submit your signed written document to your Licensing Program Analyst within three business days from the date of this meeting. The submission of your document is to be by U.S. mail to Community Care Licensing Division – Childcare Program 1515 Clay Street, 11th floor, Ste 1102, Oakland, CA 94612 attention (LPA) April Wright. Also, submit this document via email at april.wright@dss.ca.gov . Upon receipt of your document your deficiency will be cleared.

The Licensee acknowledges, that for Type A Deficiencies only upon receipt, the licensee shall post the LIC 809D / LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/ guardians of children in care at the facility and to parents/ guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/ guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. A copy of the LIC 9224 was given to licensee at time of this office visit.



A civil penalty is being assessed for one of the citations listed on this report. You will receive a bill in the mail. Payment is due when billed. Payment must be made by a personal, business or cashier check, or a money order made payable to the "California Department of Social Services". Please write the facility number and invoice number on your check and include a copy of your bill with the payment. You will find the invoice number on your bill. DO NOT SEND CASH.

An exit interview was conducted where the citation and plan of correction were discussed. Appeal rights were given and explained to the licensee Anju Tripathi.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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