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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700153
Report Date: 12/21/2021
Date Signed: 12/21/2021 10:04:56 AM

Document Has Been Signed on 12/21/2021 10:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:AGARWAL, NEETUFACILITY NUMBER:
015700153
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Neetu Agarwal- LicenseeTIME COMPLETED:
10:15 AM
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On 12/21/21 at 9:10am, Licensing Program Analyst Briana Plumboy, met with licensee Neetu Agarwal for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was licensees fingerprint clear and associated husband. LPA and licensee toured the home to conduct a Health and Safety Inspection. The facility currently plans to operate 12:00 PM to 6:00 PM., Monday through Friday.

This residence was toured for a Health and Safety Inspection. The home is neat and clean with heating and ventilation for safety and comfort.
Description of Home: The residence is a two story; which consist of 4 bedrooms, 5 bathrooms, living room with screened fireplace, dining room, kitchen, loft and attached garage.
Off Limit Areas: Entire upstairs level, and garage. The off-limit areas will be inaccessible by child safety gates, closed and/or locked doors and visual supervision.
On Limit Areas: 1st floor area on limits to children in care, which consist of living room, dining room, kitchen, bedroom that has been converted to childcare room, a full bathroom, powder room, as well as the backyard, with 100 percent supervision.
Isolation Area: living room
The stairway has child safety gating at the base of the stairs. There is a fireplace which is screened to prevent access by children in care. There are multiple smoke detectors and carbon monoxide detectors present. The facility has a fully charged 3A40BC fire extinguisher. There are age appropriate furnishings, toys, learning materials, and equipment in the day care room. The bathrooms have working toilets and faucets. Per licensee, there are no firearms located or stored on the premises. The facility has a fully fenced back yard area. There are no pools, hot tubs or other accessible bodies of water present in the facility during today's inspection. There is a fountain located in the backyard and licensee is aware there may not be standing water in it at anytime while children are in care. Hazardous items/cleaning supplies are stored where they could be inaccessible to children in care.
The licensee's Health and Safety training is completed (lead exposure included), CPR and First Aid certificate is current and expires 07-25-2022. The licensee completed and received a certificate in mandated reporter training on 07-20-2020. The licensee is in compliance with the immunization law which pertains to all day care providers. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: AGARWAL, NEETU
FACILITY NUMBER: 015700153
VISIT DATE: 12/21/2021
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Incidental Medical Services (IMS) policy was discussed. 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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Neetu Agarwal 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 Neetu Agarwal 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.

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Neetu Agarwal.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC809 (FAS) - (06/04)
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