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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700264
Report Date: 08/05/2021
Date Signed: 08/05/2021 10:03:21 AM

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, CHETNABENFACILITY NUMBER:
015700264
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
08/05/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Chetnaben ParekhTIME COMPLETED:
10:05 AM
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On August 5, 2021 at approximately 8:02am Licensing Program Analyst (LPA) Russ Haderer met with licensee Chetna Parekh for the purpose of conducting an announced Change of Location inspection for Health and Safety compliance. Present for today’s inspection was licensee and her fingerprint and TB cleared husband. Living in the home will be their two 8 year and 13 year old children. There were no children in care until the new license is issued. The hours of operation will be Monday-Friday, 8:00AM to 6:00PM.

The facility is a single story 3 bedroom, 2 bath home with an attached two-car garage. It is owned the licensee and contains a dining room, kitchen, living room, three bedrooms and two bathrooms, an enclosed (fenced) back and side yard areas and a separate courtyard area between the living room and one bedroom, and a small driveway area in the front of the home. The home is neat and clean with heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be dining room area outside of the day care area and away from the other children in care.

On-limit-areas include: Living room (day care area), kitchen, dining room, bedroom attached to the courtyard (for napping) and the main house bathroom, the courtyard area and locked back and side yards area. The exterior gate will have a padlock. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Off-limit-areas include: Master bedroom with attached master bathroom, second bedroom next to the master bedroom, attached 2-car garage and driveway area of the front yard. The off-limit areas will be inaccessible by closed and/or locked doors, and/or by child supervision.



CONTINUED ON PAGE 2.........................................................
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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, CHETNABEN
FACILITY NUMBER: 015700264
VISIT DATE: 08/05/2021
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There is a fireplace in the living room that will be blocked with heavy furniture to prevent children’s access. Per licensee, there are no firearms in the home. The licensee owns the home. Ratios were discussed and a copy left for licensee as a reminder.


Licensee has ample age-appropriate toys and learning materials. The home has a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors (tested and functioning), and a working telephone. The licensee’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 01/25/2022. The licensee completed and received a certificate in mandated reporter training (verified AB1207), expires on 05/09/2023. The licensee is in compliance with the immunization laws which pertains to day care providers.

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 Reports.


LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. Licensee has a small decorative fountain in backyard (not in use at this time). Licensee advised that if used in the future, it must be made child-proof and not contain any standing water.


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

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SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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, CHETNABEN
FACILITY NUMBER: 015700264
VISIT DATE: 08/05/2021
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Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

LPA discussed Safe Sleep for infants under 12 months of age and recent requirement for a sleep plan. LPA supplied LIC9227 form to licensee.

The licensee will be moving from her current home and moving into this new location by the end of August 2021. There are some minor items that need to be completed before a full license can be issued:

Child -proof doorknob covers for the garage door access, the master bedroom and second off-limits bedroom

Padlock for the backyard gate

Trim back large bougainvillea bush in the backyard

Add a sturdy child-proof fireplace screen and/or move furniture to block access

This home will be issued a provisional license as of 08/05/2021 until the above items are completed. Once the items listed above are in place, and an inspection has been done (or photos sent to LPA) to confirm it, a full license may be issued.

This report shall remain on file for 3 years.

Exit interview was conducted, LPA left at 10:05am

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
LIC809 (FAS) - (06/04)
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