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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621975
Report Date: 06/20/2019
Date Signed: 06/20/2019 12:25:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CHANDRA, SHAREENFACILITY NUMBER:
343621975
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
06/20/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Shareen ChandraTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Marea Behvand and Seychelle De Luca met with Shareen Chandra for an unannounced case management inspection. Upon arrival, LPAs observed that an alteration was made to the facility prior to notifying the department. LPAs informed Licensee that no construction may take place until Licensee notify's CCL. Licensee requests to make the backyard and patio area off-limits. Effective today, the backyard and patio area are off-limits. Licensee acknowledges she must contact LPA Behvand prior to making an off-limit are on-limits, and vice versa.

A deficiency is cited on the subsequent page of this report. A Notice of Site Visit was posted and Appeal Rights were provided.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CHANDRA, SHAREEN
FACILITY NUMBER: 343621975
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2019
Section Cited
CCR
102416.3(a)
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Alterations to Existing Buildings or Grounds a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed. This requirement was not met as evidenced by LPAs observed construction is currently taken place without notifying LPA. This poses a potential safety concern.
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Licensee shall provide a statement acknowledging that she understands reporting requirement in regards to any building modification or alterations to the child care facility. Deficiency was cleared during today's inspection.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2