015700185-2-2-2021-52-CC-RRED-BXV2UQ-20210202164242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700185
Report Date: 02/02/2021
Date Signed: 02/02/2021 04:43:26 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:	CHITRANSHI, MANISHA		FACILITY NUMBER:	015700185
ADMINISTRATOR:	CHITRANSHI, MANISHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 264-1552
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	14	CENSUS:	DATE:	02/02/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:04 PM
MET WITH:	Manisha Chitranshi		TIME COMPLETED:	04:30 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	Due to Covid-19 Pandemic this Inspection is being done Via FACETIME Licensing Program Analyst, (LPA) Renee Reed conducted an announced Pre-Licensing tele- inspection for a Large Change of Location, on Tuesday, 2/2/2021 at approximately 2:00 PM. Tele-Inspection conducted and toured the residence with applicant Manisha Chitranshi, and applicant's fingerprint cleared husband Sunit Srivastava. Also present at the home was applicant's 6 year old daughter and 1 year old son. Applicant's hours of operation will be Monday thru Friday from 8:00 AM to 6:00 PM. This residence was toured for a Health and Safety Inspection. The home is neat and clean with heating and ventilation for safety and comfort. Description of Home: The residence is a single story, which consist of 3 bedrooms, 2 bathrooms, living room kitchen/dining room combo backyard and attached garage. Off Limit Areas: Master Bedroom w/bathroom, 1st bedroom to the right of home, shed in backyard and garage. On Limit Areas: Living room, dining room/kitchen combo, 2nd bedroom to the right all converted to a day care room, a full bathroom, as well as the backyard. Isolation Area: corner in 2nd bedroom converted to day care room. 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: 02/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

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: CHITRANSHI, MANISHA	FACILITY NUMBER: 015700185
	VISIT DATE: 02/02/2021

NARRATIVE

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There are multiple working smoke detectors and carbon monoxide detectors present. The facility has a fully charged 3A40BC fire extinguisher and a pull down fire alarm. Fire Clearance was granted by Dublin Fire Prevention Services on 01/12/2021 (noted garage off limits to children). There 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 home has a fully fenced back yard area and a locked storage shed. There is a swing set in the grass area of backyard. LPA had applicant's husband shake the swing set for sturdiness and stability, as well as, had the applicant swing on it. There are no pools, hot tubs or other accessible bodies of water. There are two locked gates on each side of the home. Hazardous items/cleaning supplies are stored inaccessible to children in care. All electrical outlets are safety outlets. Covid-19 Postings were posted, LPA and applicant went over the Covid-19 Self Assessment guide.

LPA reminded the licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Report. LPA reminded applicant an assistant must be present when there are more than 8 children in care.

Applicant 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. LPA discussed the new Guardian System and provided the a the link below. https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

This facility is approved for the Large Change of Location. A copy of this report was issued to licensee by email and is to remain in the facility records for a period of three years.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

LIC809 (FAS) - (06/04)

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