013422899-1-25-2023-52-CC-MMAW-CNF332-20230125165250

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422899
Report Date: 01/25/2023
Date Signed: 01/25/2023 04:53:02 PM

Document Has Been Signed on 01/25/2023 04:53 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:	TULSIANI, SANGEETA		FACILITY NUMBER:	013422899
ADMINISTRATOR:	TULSIANI, SANGEETA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 739-3848
CITY:	NEWARK	STATE: CA	ZIP CODE:	94560
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	01/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Sangeeta Tulsaini		TIME COMPLETED:	05:07 PM

NARRATIVE

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On 1/25/2023 at 2:30 Pm Licensing Program analyst (LPA) Michael Mathew Conducted an unannounced annual visit LPA met with Licensee Sangeeta Tulsaini and discussed the purpose of the Visit. Prior to entering the home LPA conducted Covid-19 screening questions. Licensee and LPA, toured inside and out of the home. At the time of the visit there were 9 children and 2 adult. There are age-appropriate toys and equipment for children in care.

Licensee uses the living room, playroom, hallway bathroom, and backyard for the day-care. Licensee stated that there are no guns/weapons or ammunition in the home. LPA observed the knifes are kept in the corner of the kitchen next to the stove inaccessible to children in care. LPA observed chemicals and toxins are kept under the sink locked and inaccessible to children in care. Backyard is fully fenced in and have ample number of toys and equipment for children in care. Licensee stated that Licensee uses park behind licensee house LPA observed the park has ample amount of space for children to play. LPA observed soft rubber padding under the play structure to help protect the children when they fall LPA observed no bodies of water during inspection. LPA observed a 2A10BC fire extinguisher present, Fire alarm and carbon monoxide detector are good and in working condition. Licensees CPR/first aid is current and is valid until 2/13/2024. . Licensee and one assistant present have current mandated reporter training valid until 2/19/24 and 2/18/24. Fire drill was conducted on 1/5/23. Licensee was not able to provide LPA with a 15 minute sleep check document. Licensee stated that licensee was not aware that sleep check need to be documented.

The facility is currently not providing Incidental Medical Services. 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

809-C

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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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Document Has Been Signed on 01/25/2023 04:53 PM - It Cannot Be Edited

Created By: Michael Mathew On 01/25/2023 at 03:45 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: TULSIANI, SANGEETA	FACILITY NUMBER: 013422899
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. Licensee was not able to provide LPA with 15 minute sleep check. Licensee stated that licensee was not aware that sleep check need to be documented.
	POC Due Date: 01/27/2023
	Plan of Correction
1 2 3 4	Licensee agreed to send completed 15-minute check to LPA via text or email by end of day Friday 1/27/2023. Licensee also agreed to send a letter to LPA stating how this wont happen in the future.

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:

Wynn Norona

LICENSING EVALUATOR NAME:

Michael Mathew

LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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: TULSIANI, SANGEETA	FACILITY NUMBER: 013422899
	VISIT DATE: 01/25/2023

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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.

Licensee 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.

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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee.

one type B deficiency was cited in today’s visit.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

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