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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423341
Report Date: 01/30/2023
Date Signed: 01/30/2023 02:52:41 PM


Document Has Been Signed on 01/30/2023 02:52 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, SHIBANIFACILITY NUMBER:
013423341
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
01/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sahu Shibani TIME COMPLETED:
03:00 PM
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On January 30, 2023 at approximately 2:00 PM Licensing Program Analyst (LPA) Lorraine Dacanay Breaux arrived at the facility for an announced Case Management-Change of Capacity Inspection. LPA met with licensee Sahu Shibani. Also residing in the home and present during today's inspection is the licensee’s fingerprint and TB cleared husband Binay Sahoo. The facility is a two story house. Hours of operation for child care are Monday through Friday, 8:30 am to 5:30pm.

ON LIMITS: Home entry for traveling to living room (main day care area), dining room, family room, kitchen, 1 bedroom (main floor) used for napping, main bathroom and rear yard.



OFF LIMITS: The small room/office on main level, two car garage, entire upstairs, which includes master bedroom and bathroom and 2 additional bedrooms and 2 bathrooms. Isolation Area: The family room away from children in care until parents pick up. Per licensee, there are no firearms and no pets in the home. The outdoor play area is the fully fenced backyard and LPA observed that it is free from defects or dangerous conditions. There are no changes to the home since the last inspection visit on 07/11/2022.Licensee is reminded to operate as a Family Child Care Home (large), which may have a maximum capacity of twelve (12) to fourteen (14) children.

A fire clearance for 14 was approved on 01/23/2023. LPA reviewed the application prior to this visit and the home has an approved fire clearance from the Livermore - Pleasanton Fire Department.

There are no deficiencies cited today. Notice of Site visit was provided to the licensee to be posted for the next 30 days. Exit interview conducted and report was reviewed with the licensee, Sahu Shibani.

Based on the approval of the fire clearance, issuance of license is recommended for this home effective today 1/30/2023. Licensee is approved for the Change of Capacity as of 01/30/2023.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2023
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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