013423341-8-6-2021-52-CC-LDBX-C5MT63-20210806142629

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423341
Report Date: 08/06/2021
Date Signed: 08/06/2021 02:26:40 PM

Document Has Been Signed on 08/06/2021 02:26 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	SAHU, SHIBANI		FACILITY NUMBER:	013423341
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	08/06/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Shibani Sahu		TIME COMPLETED:	02:45 PM

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	On August 6, 2021 Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an unannounced ANNUAL/RANDOM inspection. Present during today’s inspection was licensee Shibani Sahu, fingerprint cleared husband B. Sahoo, their two children ages 13 and 15 years old and 5 (five) children in care. The home was toured for Health and Safety Inspection with licensee. Hours of operation are Monday - Friday 8 AM - 6 PM. ON LIMITS: area consist of the home entry for traveling to living room (main day care area), dining room, family room, kitchen, 1 bedroom (main floor) used for napping, bathroom adjacent to the living room. OFF LIMITS: The small room/office on main level, two care garage, entire upstairs and master bedroom and bathroom, and the entire yard area is taking off limits, family states they are getting the deck removed/repaired. Licensee understands that the back yard is not to be used until the area is reinspected. Required postings were all present. Postings included: License Emergency Disaster Plan Earthquake checklist Notification of Parents Rights Seat Belt Safety Law Licensee understands she needs to relocate the current parent board from the napping room to the entry of the home for parents access. The home was observed to be orderly, with heating and ventilation for safety and comfort. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. Per licensee, there are no firearms on the premises. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored away. The fireplace is barricaded to prevent access by children. The home is equipped with both a smoke detector and carbon monoxide detector. There is a fully charged 3A40:BC. fire extinguisher. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. No Pets.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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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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: SAHU, SHIBANI	FACILITY NUMBER: 013423341
	VISIT DATE: 08/06/2021

NARRATIVE

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The licensee was reminded that children are not to be left in parked vehicles. The licensee is operating within the licensed capacity. LPA did not observe any child left without supervision during the inspection. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed.

Children files were reviewed. Files reviewed contain children’s emergency information. The licensee has current CPR and First Aid which expires 11/09/21.

Fire and disaster drills are conducted at least once every six months. Last Drill was completed on 05/17/21

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

Incidental Medical Services (IMS) was discussed. The following information regarding ADA was provided to licensee. US DOJ toll free ADA Information Line (800)514-0301 FAQ and ADA http://www.ada.gov/childqanda.htm LPA discussed the requirement to create a plan of operation when needed. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SAHU, SHIBANI	FACILITY NUMBER: 013423341
	VISIT DATE: 08/06/2021

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Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

The licensee was advised of the required mandated reporter training to be completed every two year www.mandatedreporterca.com. Licensee will complete they mandated reporter training by August 31, 2021.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. This entire report was read to licensee by LPA. Exit interview conducted

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

LIC809 (FAS) - (06/04)

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