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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422758
Report Date: 12/16/2024
Date Signed: 01/15/2025 04:21:13 PM

Document Has Been Signed on 01/15/2025 04:21 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/
DIRECTOR:		TRIPATHI, ANJUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 666-6320
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Anju TripathiTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On December 16th, 2024 at 9:35am, Licensing Program Analyst (LPA) April Wright arrived at the home of Licensee Anju Tripathi to delivery complaint investigation findings. Present were ten (10) children (3 infants/6 preschool) and the licensee fingerprint cleared assistant and spouse.

Upon LPA arrival to the home, LPA observed the Licensee assistant Nusratbibi Khan in the kitchen window as LPA approached the door. LPA viewed through the front door window and observed Assistant Nusratbibi "running" to another room in the home but had not opened the door for the LPA. LPA further observed through the front door window, the assistant opening the closed door of the daycare room where children were left unsupervised.
Licensee then opened the front door of the home and allowed LPA to enter. LPA asked Licensee why was the assistant was not present in the daycare room with the children and why was the door closed. Licensee stated the door was not closed and assistant was prepping food for the children. LPA advised Licensee that the LPA visually observed through the front door window that the assistant was not in the room with the children at the time of arrival and observed the closed daycare room door. LPA and licensee went to the daycare room and the door was locked, LPA knocked and the assistant opened the door. LPA asked the Licensee if the assistant was not present and children were left unsupervised in the daycare room. Licensee confirmed that they were alone and assistant was not present in the daycare room. Licensee stated they were in the napping room which is not in visual or physical supervision of the children in care.

LPA observed that their was no visual or physical supervision possibly from the kitchen area or napping room. LPA observed assistant not present in the daycare room at time of arrival to the home.

See LIC809C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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Document Has Been Signed on 01/15/2025 04:21 PM - It Cannot Be Edited


Created By: April Wright On 12/16/2024 at 12:07 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: TRIPATHI, ANJU
FACILITY NUMBER: 013422758

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/17/2024
Section Cited
HSC
102417(a)

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Operation of a Family Child Care Home:

(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times.
This requirement is not met as evidenced by:
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Licensee proposed plan of correction to LPA by removing the lock of daycare room and obtaining better monitoring and supervision of children with their assistant. Licensee will meet with assistant and go over how to provide better supervision of children in care and construct a written plan of supervision.
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LPA observed upon arrival through front door window, Licensee assistant opening a closed door where daycare children present, children were alone and with no visual or physical supervision provided, which poses a immediate risk to the health, safety, and personal rights of the children in care
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Additionally, Licensee and assistant shall watch the CCLD video, "Supervising Children in family childcare" and write a statement of understanding pertaining to how to properly supervise children in a child care setting. Licensee will submit proof of video review, supervision plan and door removal to LPA by 12/17/24.

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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:April Wright
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2024


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: 12/16/2024
NARRATIVE
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Based on LPA observations and admission by the Licensee and assistant, an immediate Type A violation is being cited for Lack of Supervision. California Code of Regulations, Title 22, Division 12, Chapter 1, Section 102417(a), is being cited on the attached LIC809D and must be corrected by 12/17/2024 per plan of correction provided by licensee to the LPA.

LPA provided copy of the Health and Safety code regulations for "Operation of a Family Child Care home" for the licensee review and for clarification.

Report was read and reviewed with Licensee Anju Tripathi.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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