304312043-5-20-2019-06-CC-GCOY-BCCMUC-20190520095455

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312043
Report Date: 05/20/2019
Date Signed: 05/20/2019 09:55:04 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	RASTA, MAHJAN		FACILITY NUMBER:	304312043
ADMINISTRATOR:	RATSA, MAHJAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 481-6748
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92673
CAPACITY:	10	CENSUS: 7	DATE:	05/20/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Mahjan Rasta		TIME COMPLETED:	10:15 AM

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	An annual inspection was made today by Licensing Program Analyst (LPA) Connolly. Present was licensee, licensee's assistant and seven children in care two of whom infants. All children were awake and actively engaged in the activities of the day care. Licensee is operating within the capacity limitations of the license. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. All areas identified on the facility sketch were inspected. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The home, clean and in good repair, is two story attached. Gate was in place at the bottom of the staircase that leads to the second story of the home. Gates are also in place to prevent children entry into the kitchen. A gate is in place at the entrance of the family room/dining area, the primary area of the home designated for day care purposes. The fire extinguisher, smoke detector and carbon monoxide detector are operational. Licensee's pediatric CPR and First Aid cards are current until 4/6/2021. Disaster drills practised with children in care are documented. Fireplace is screened. The fenced side yard is designated as the out door play area for children in care. Outdoor toys that appear age appropriate for ages served are located here. During today’s visit LPA discussed incidental medical services with the licensee. Licensee said there are no incidental medical services being provided at this time. Continued on page two

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RASTA, MAHJAN	FACILITY NUMBER: 304312043
	VISIT DATE: 05/20/2019

NARRATIVE

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Children paperwork and roster were reviewed.

The licensee was reminded of the following:
1.) Always place infants on their backs for sleeping.
2.) Use only a tight-fitting sheet on the crib or play yard mattress.
3.) Do not hang any items from the crib or above the crib.
4.) Keep all items, including blankets, out of the crib or play yard.
5.) Pacifiers may be used as long as they do not have items attached to them.
6.) Infants should not be swaddled or have any items covering them while sleeping.

In the areas that were evaluated no deficiencies were observed of the California Code of Regulation, Title 22, and Division 12 at the time of the inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100.00. The 'Notice of Site Visit' ' must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2019

LIC809 (FAS) - (06/04)

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