015700168-6-6-2023-52-CC-SCOZ-CSJT9C-20230606143142

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700168
Report Date: 06/06/2023
Date Signed: 06/06/2023 02:32:30 PM

Document Has Been Signed on 06/06/2023 02:32 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:	RAJ, BETSY		FACILITY NUMBER:	015700168
ADMINISTRATOR:	RAJ, BETSY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 396-8988
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	06/06/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	02:07 PM
MET WITH:	Betsy Raj		TIME COMPLETED:	03:48 PM

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LPA Cortez conducted a health and safety inspection, to re-activate the license of licensee Betsy Raj.

Licensee plans to operate the facility Monday through Friday from 7:00am until 6:00pm. Present for this visit is the Licensee. The home was toured to conduct a Health and Safety Inspection. The home is two stories. The home consists of 4 bedrooms, 3 bathrooms, living room, dining, kitchen, garage and backyard. There is no pool or any type of bodies of water in the home. According to the licensee, and visually confirmed by LPA Cortez, there is no fire-arm in the house.

The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the 3 upstairs bedroom, 2 bathrooms upstairs, kitchen.

The ON LIMIT AREAS are the dining room, living room, 1 bathroom, 1 bedroom, and the backyard play area, and the garage area for activities. Licensee indicated that while children are playing in the backyard there will be someone to supervise them at all times.The ISOLATION AREA will be the living room located on the right side of the house. Mandated Reporter is current, will expire June 2025. CPR and First Aid is current and will expire on June 2025

There are toys and learning materials in the activity room area. Outdoor play area will be located in the backyard area of the home and can be accessed through the sliding door via the activity room. The outdoor play area is fenced.

Hazardous materials and toxins are kept out of the reach of children and it was observed that there would be no toxins or hazardous items accessible to children during today's inspection.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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: RAJ, BETSY	FACILITY NUMBER: 015700168
	VISIT DATE: 06/06/2023

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LPA Cortez provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee. LPA Cortez provided licensee with a copy of the CDSS handout on Effects of Lead Exposure and Never Shake a Baby Brochure (attached PUB 271)
The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.California Law requires Family Child Care Home 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 by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.
The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.
Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, 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
For licensing updates email [email protected] and ask to be added to the email list

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

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