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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700285
Report Date: 09/20/2023
Date Signed: 09/20/2023 02:24:18 PM

Document Has Been Signed on 09/20/2023 02:24 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:SINGH, SWATIFACILITY NUMBER:
015700285
ADMINISTRATOR:SINGH, SWATIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(313) 330-2385
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
09/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Swati SinghTIME COMPLETED:
03:15 PM
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On 09/20/23 at 1:00PM, Licensing Program Analysts (LPA) Lorraine Dacanay Breaux met with licensee Swati Singh for an UNANNOUNCED 1 YEAR REQUIRED ANNUAL INSPECTION. Present for the inspection were 11 toddler age children and fingerprint cleared assistant. The home was toured to conduct a Health and Safety Inspection inside and out. The facility currently operates Monday - Friday 8:30 am- 5:00pm.

This is a single story home with 4 bedroom and 2 bathrooms. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort. LPA reviewed Insurance and expires 04/12/24.

On-limit-areas include: Entryway of the home, living room, dining room, kitchen, master bedroom and bathroom (used for child care), hallway leading to master bedroom. The rear yard that is fully fenced. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits areas.

Off-limit-areas include: The three bedrooms down the hallway, bathroom in the hallway (main house bathroom), the attached 2-car garage, the front yard of the home, and the locked shed in the back yard. The off-limit areas will be inaccessible by closed and/or locked doors, child safety gates and/or by adult visual supervision.



All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 2A10BC fire extinguisher in dining room area, working smoke detector, carbon monoxide detector, telephone and fully stocked first aid kit. Per licensee, there are no firearms on the premises.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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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: SINGH, SWATI
FACILITY NUMBER: 015700285
VISIT DATE: 09/20/2023
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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 09/05/25. The licensee is in compliance with the immunization laws and has completed the mandated reporter training. Licensee is reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The licensee conducts and documents fire and disaster drills at least twice a year. All required forms are posted and visible for public review.

Records: At 1:45 PM LPA Dacanay Breaux request and reviewed children’s files and personnel records. Facility does not provide care to children under 12 months and therefore does not need to meet Safe Sleep Requirements. There is a current roster available for review and obtained a copy. The facility does have liability insurance which is valid through 09/14/24.

CCLD Inspection Process: 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/process.

Criminal Record Clearance: 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.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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/resources/child-care-centers/.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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: SINGH, SWATI
FACILITY NUMBER: 015700285
VISIT DATE: 09/20/2023
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MyChildCarePlan.org: Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law: During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

No deficiencies found during today's inspection.


A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided. 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, Swati Singh.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC809 (FAS) - (06/04)
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