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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422777
Report Date: 05/09/2024
Date Signed: 05/09/2024 10:27:31 AM

Document Has Been Signed on 05/09/2024 10:27 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:VERMA, MONIKAFACILITY NUMBER:
013422777
ADMINISTRATOR/
DIRECTOR:		VERMA, MONIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 996-3376
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Licensee, Monika VermaTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Jyoti Saini conducted an annual random inspection with Licensee Monica Verma. The licensee, fingerprint-cleared husband and son, were present during the inspection. There were no children present during today's inspection. During the inspection, the Licensee indicated that she has not provided child care services since 04/2024 and wishes to place her license inactive for a year. LPA obtained the necessary documentation during the inspection to place the license inactive. LPA and Licensee had a detailed discussion about placing the license inactive or extending the inactive status if the licensee decides to resume child care services. LPA also advised the Licensee of the conditions of being on Inactive Status. The Licensee has agreed to the terms and conditions. LPA updated the licensee that the licensee would receive a new license within ten business days, reflecting inactive status.

For licensing updates, email [email protected] and ask to be added to the email list.

No deficiencies were cited today.

An exit interview was conducted, and the report was reviewed with licensee, Monica Verma.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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