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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313424
Report Date: 01/16/2024
Date Signed: 01/16/2024 12:27:01 PM


Document Has Been Signed on 01/16/2024 12:27 PM - It Cannot Be Edited

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:CHAUDHARY, SHWETAFACILITY NUMBER:
304313424
ADMINISTRATOR:CHAUDHARY, SHWETAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 373-6781
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY:14CENSUS: 0DATE:
01/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Shweta Chaudhary - LicenseeTIME COMPLETED:
12:45 PM
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An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Carmen Odom. Upon arrival LPA met with Licensee Shweta Chaudhary. There were no children present in the facility. Licensee stated as of 12/24/23 the childcare has been closed due to medical leave until 5/30/24. Licensee stated they informed all the parents and staff on December 2,2023 of the temporary closure. There were no adults or minor children that live in the home present.

A review of adult records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's visit LPA interviewed licensee, obtained children's roster and staff information. LPA provided the LIC9211 Inactive request form, licensee completed the form requesting to place license on inactive status from 12/24/23 to 05/30/24. Licensee stated they plan to reopen the license in June if the surgery goes well if not they will extend their inactive status.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024
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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