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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422521
Report Date: 06/09/2020
Date Signed: 06/09/2020 12:48:47 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:PAREKH, JIGNAFACILITY NUMBER:
013422521
ADMINISTRATOR:PAREKH, JIGNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 709-5094
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 0DATE:
06/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Jigna ParekhTIME COMPLETED:
01:00 PM
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Due to the Covid-19 Pandemic, a site inspection could not be conducted in person. LPA Simerjit Kaur conducted a Case Management Incident Inspection via Face Time. Present during this inspection was licensee's daughter Shefali Parakh, husband Rajesh Parakh, Assistant Nayanaben Patel, mother-in-law Indira Parekh, father-in-law Gunvantrai Parekh.

Case Management inspection was conducted due to an Unusual Incident, which occurred on 02/21/2020 at the day care facility. It was revealed during a complaint investigation, a child was injured during the operation of the day-care. Licensee fail to report the incident to Community Care Licensing Department- Child Care Program.

During this inspection the Licensee is being cited under the Health and Safety Code Reporting Requirements -1597.467(b)(1)(A) through (b)(1)(c).

See 809D for deficiency cited.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 622-2632
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2020
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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