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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700168
Report Date: 07/25/2023
Date Signed: 07/25/2023 01:08:08 PM

Document Has Been Signed on 07/25/2023 01:08 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, BETSYFACILITY NUMBER:
015700168
ADMINISTRATOR:RAJ, BETSYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 396-8988
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
07/25/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:21 PM
MET WITH:Betsy RajTIME COMPLETED:
02:15 PM
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The purpose of the inspection was to conduct an ANNOUNCED INSPECTION to activate and inactive license. 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. Present in this visit is the licensee (Betsy Raj) and 2 pre school age children.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.
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. Mandated Reporter is current, will expire June 2025. CPR and First Aid is current and will expire on June 2025. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, telephone, and fully stocked First Aid Kit. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on June, 2023. 2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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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