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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422521
Report Date: 12/06/2021
Date Signed: 12/06/2021 01:02:24 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: 7DATE:
12/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:29 AM
MET WITH:Jigna Parekh- LicenseeTIME COMPLETED:
01:15 PM
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On 12/6/21 at 11:29am, Licensing Program Analyst Briana Plumboy, met with licensee Jigna Parekh for the purpose of an UNANNOUNCED RANDOM INSPECTION. Present for this visit was fingerprint clear assistant Manjinder Kaur, licensee's husband Rajesh Parekh, and licensees fingerprint clear and associated father in law Gunvantrai Parekh, 2 infants, and 5 preschool age children. The home was toured to conduct a Health and Safety Inspection upon LPA's arrival. The facility operates Monday through Friday from 8:00am until 6:00pm.

The home is a two story home. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the family room, downstairs bathroom, and the backyard. The family room is padded with cushioning and per licensee is the primary room for care. The OFF LIMIT AREAS are the downstairs master bedroom and master bathroom, living room, dining room, kitchen, garage, and the entire 2nd story of the home which will be inaccessible by closed and/or locked doors and visual supervision. There is a fireplace located inside the family room which is barricaded by a couch and glass door to prevent access by children. The ISOLATION AREA will be an area in the family room. The backyard has a built in barbecue grill and fountain. The fountain has a wall built around it to prevent access by children in care. The home previously had a stone fireplace built inside the backyard, but the licensee has removed it. The backyard has gates on the left and right side of the home to prevent the access of the sides of the home to children in care. There are no play structures inside the backyard today.

The licensee utilizes the form Lic. 282. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee CPR and First Aid certificate is current and expires 06/27/2022, and her assistant present today's CPR/First Aid expires 8/11/23. The licensee's mandated reporter training is expired and her assistant present today has not completed the training. The licensee and her assistant present are in compliance with the immunization law which pertains to providers. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 07/26/21. See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: PAREKH, JIGNA
FACILITY NUMBER: 013422521
VISIT DATE: 12/06/2021
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Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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



LPA discussed the safe sleep regulations with licensee Jigna Parekh and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Jigna Parekh of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

See 809-D for deficiency cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Jigna Parekh.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: PAREKH, JIGNA
FACILITY NUMBER: 013422521
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above due to hert mandated reporter training being expired as well as her assistant present does not have a current mandated reporter training certificate on fiel which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/06/2022
Plan of Correction
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Training can be found at mandatedreporterca.com.
The licensee and assistant present must complete the mandated reporter training by 1/6/22 and submit to LPA by email or mail.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2021
LIC809 (FAS) - (06/04)
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