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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422797
Report Date: 09/23/2019
Date Signed: 09/23/2019 03:05:43 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 GANDHI, SANGITABENFACILITY NUMBER:
013422797
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
09/23/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sangitaben Patel GandhiTIME COMPLETED:
03:30 PM
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On 09/23/19, Licensing Program Analyst Briana Plumboy met with the licensee Sangitaben Patel Gandhi for a case management inspection. The licensee has submitted an application for an increase of capacity. The home was toured to conduct a health and safety inspection.
The home is two levels. The home consists of a family room, living room, kitchen, garage, 5 bedrooms, a laundry room, and 3.5 bathrooms. The home appears to be neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the garage, downstairs master bedroom with bathroom, and the entire second level of the home which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the family room, living room, kitchen, and downstairs bathroom. When there are children in care, licensee is aware there must be a gate at the bottom of the stairs to prevent access to children under the age of 5 years old to the second level of the home. The ISOLATION AREA will be the living room. Outdoor play area will be the fenced backyard, and per licensee the children will not play on the left side of the home. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. LPA reminded the licensee to keep all of the rooms in a safe and healthful condition, at all times. The licensee has provided proof of the required immunization's. Licensee has a current CPR/First Aid certificate that expires 07/24/21. The licensee received a certificate of completion in mandated reporting on 09/21/19. A fire clearance for 14 was received on 09/23/19. Per the fire clearance, there can be no day care activity allowed in the downstairs bedroom off of the kitchen or upstairs at anytime.
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. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.
There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. Exit interview conducted. The increase of capacity will be effective today, and the new license will be mailed.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019
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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