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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700264
Report Date: 09/03/2021
Date Signed: 09/03/2021 04:08:34 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, CHETNABENFACILITY NUMBER:
015700264
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
09/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Chetnaben ParekhTIME COMPLETED:
04:15 PM
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On September 3, 2021 at approximately 3:25pm Licensing Program Analyst (LPA) Russ Haderer met with licensee Chetnaben Parekh for the purpose of conducting an unannounced inspection to clear items needed to change the recently issued license from provisional to full license.

Present for today’s visit was licensee’s fingerprint and TB cleared husband, their 13-year-old son and 4 children in care today (1 infant, 3 toddlers). The licensee’s 8-year-old daughter and her friend arrived home after school.

The items needed to be finalized were:

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

All items on the above list have been completed (other than a padlock which now has a 41/2 inch screw/bolt in place on the hasp preventing it from being opened from the outside).

Effective this day, the full regular license is approved.

A notice of site visit was printed and must be posted for 30 days.

LPA left facility at 4:15pm.

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

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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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