013421710-7-21-2021-52-CC-RRED-C55UHZ-20210721153647

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421710
Report Date: 07/21/2021
Date Signed: 07/21/2021 03:36:55 PM

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:	PATEL, MONAL		FACILITY NUMBER:	013421710
ADMINISTRATOR:	PATEL, MONAL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 865-0561
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	14	CENSUS: 13	DATE:	07/21/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:47 PM
MET WITH:	Monal Patel		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 7/21/2021 at approximately 1:47 PM Licensing Program Analyst Renee' Reed met with licensee Monal Patel for an 1 YEAR UNANNOUNCED INSPECTION. Present for this inspection was Licensee's fingerprint cleared assistant/daughter,Vasvi Patel mother in law Bharti, husband Apurva., 2 school age and 11 preschool age children. The home was toured to conduct a Health and Safety Inspection. Licensee operates Monday through Friday from 8:30AM to 6:00PM. The home is neat and clean with heating and ventilation for safety and comfort. ON LIMIT AREAS: The first floor level which included home living room, bedroom with attached bathroom, 1/2 bathroom, dining room, wet bar area, family room, kitchen with dining area and backyard. ISOLATION AREA: the living room. OFF LIMITS: The entire upstairs which is inaccessible by closed and/or locked doors, safety gates and visual supervision. During inspection LPA observed documents are posted in a prominent, publicly accessible are at the facility. Fire and Disaster drills are to be conducted every 6 months; last conducted on 4/16/2021. Carbon Monoxide and Smoke Detector was tested and in working order. Licensee has a fully charged 2A10BC fire extinguisher and pull down fire alarm. There here are age appropriate furnishings, toys and equipment in the day care room. The bathroom has working toilet and faucet in new condition. Per Licensee there are no firearms located or stored on the premises. The facility has a fully fenced back yard area with ample age appropriate toys. There are no pools, hot tubs or other accessible bodies of water observed during today's visit. Hazardous items/cleaning supplies are stored inaccessible to children in care. All electrical outlets are safety outlets. See 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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: PATEL, MONAL	FACILITY NUMBER: 013421710
	VISIT DATE: 07/21/2021

NARRATIVE

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LPA reviewed 5 children's files and all required documents were complete. 1 staff file reviewed and all required documents are complete.

Licensee is in compliance with immunization laws pertaining to child care providers. Licensee's CPR & First Aid is current and expires 5/9/2023. Mandated Reporter Training is current and expires 3/8/2022. Licensee's assistant Stela left for the day, however Licensee's daughter assisted today and LPA advised when daughter is assisting she will need a mandated reporter training certificate which includes General and Child Care Providers. Licensee will submit by the end of next week.

Licensee is reminded CPR & First Aid is to be renewed every 2 years and Mandated Reporter Training to be renewed every two years. LPA provided and discussed LIC 9227 Individual Safe Sleep Regulations

Licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

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.

No deficiencies were cited today. A Notice of Site Visit was provided and must remain posted for 30 days.

Exit interview conducted. Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

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