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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422944
Report Date: 12/20/2024
Date Signed: 12/20/2024 04:05:49 PM

Document Has Been Signed on 12/20/2024 04:05 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:AGARWAL, SHRUTIFACILITY NUMBER:
013422944
ADMINISTRATOR/
DIRECTOR:		SHRUTI AGARWALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(518) 836-8473
CITY:LIVERMORESTATE: CAZIP CODE:
94551
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 9DATE:
12/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Shruti AgarwalTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 12/20/2024 at 1:30PM Licensing Program Analyst (LPA) Jaleesa Jackson arrived for an Unannounced Annual/Random Inspection and met with Licensee Shruti Agarwal. LPA informed Licensee of the nature of the visit and was granted entry into the home. Present for this inspection was the Licensee, 2 fingerprint cleared assistants, 5 school aged children (including one assistant's child) and 4 infants. Also present during the inspection in an off limits area were the Licensee's husband and their minor son. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:30AM to 5:30PM.

ON LIMITS: Main house downstairs only (Family Room, Living Room, Downstairs Bathroom, and Kitchen), Additonal Dwelling Unit (ADU) (Daycare Room with Kitchen area, Nap room, Bathroom), and the Backyard

OFF LIMITS: Main house second floor and the converted Garage

The home is a two story home with an ADU owned by the Licensee. The home has heating and ventilation for safety and comfort. There were age appropriate toys that were observed to be safe and in good condition. During today's inspection all toxins, medicines, and hazardous items were inaccessible. There is a fully charged fire extinguisher, working combination smoke/carbon monoxide detector and telephone in the home. Licensee stated that there are no firearms and no one who smokes at the home. Licensee stated she has 1 dog. LPA did not observe any harmful bodies of water in or around the home. The facility provides breakfast, lunch, and snacks to children. All children that bring their own snacks and lunches from home will be properly labeled and stored.

LPA reviewed 8 children's files. Licensee CPR and First Aid is current and expires 6/25/2025. Licensee mandated reporter training is current and expires 8/17/2025. Disaster drills are conducted at least every six months. The last drill was conducted 11/21/2024. All required documents are posted.
Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: AGARWAL, SHRUTI
FACILITY NUMBER: 013422944
VISIT DATE: 12/20/2024
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There were no deficiencies cited on today's inspection.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: AGARWAL, SHRUTI
FACILITY NUMBER: 013422944
VISIT DATE: 12/20/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Shruti Agarwal, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee Shruti Agarwal.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
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