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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423341
Report Date: 08/01/2024
Date Signed: 08/01/2024 03:06:46 PM

Document Has Been Signed on 08/01/2024 03:06 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SAHU, SHIBANIFACILITY NUMBER:
013423341
ADMINISTRATOR/
DIRECTOR:		SAHU, SHIBANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 829-5471
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Shibani SahuTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On August 1, 2024, at approximately 01:30PM, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an Unannounced Required 1 Year Inspection. Present during today’s inspection was licensee Shibani Sahu, and six (6) children in care, (2 infants and 4 preschool age children). The home was toured for Health and Safety Inspection with licensee. Hours of operation are Monday - Friday 8:30 AM - 5:30 PM.

This two story home consisting of five (5) bedroom and three (3) bathrooms. The home is neat and clean with heating and ventilation for the safety and comfort of children in care.

ON LIMITS: Main entry for traveling to living room (main day care area), dining room, family room, kitchen, one bedroom (first floor) used for napping, and main bathroom on first floor.


OFF LIMITS: The small room/office on main level, entire upstairs which includes the master bedroom and bathroom and the 2 car garage. Isolation Area: The living room away from children in care, until parents pick up. The off-limits are will be made inaccessible by closed and/or locked doors safety gate and visual supervision.

There's a gate at the bottom of the stairs to prevent access. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. Licensee confirmed that there are no pools/bodies of water at the home. Licensee confirmed there are no firearms or pets. Licensee confirmed that she resides in the home, and does not provide transportation. Licensee is reminded that when operating as a large day care, licensee must have an assistant otherwise, licensee can only have the capacity of a small day care. The home has a pull down fire alarm system, working smoke detector, working carbon monoxide detector, first aid kit, telephone, and fully charged 3A40BC fire extinguisher, located in the garage. There's a fireplace in the living room which is screened to prevent access by children.

809-C
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SAHU, SHIBANI
FACILITY NUMBER: 013423341
VISIT DATE: 08/01/2024
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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 09/30/2025 and has completed the mandated reporter training on 01/08/2024. Licensee is reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 06/10/24. All required forms are posted and visible for public review.

Records: At 2:20 PM, LPA Breaux requested and reviewed children and staff files. LPA reviewed three (3) children’s files, personnel records, and Facility Roster. Individual Infant Safe Sleep Plans are complete and in child's file. Sleep Charts for sleeping infants were reviewed and within compliance of the Safe Sleep Regulations. The facility does not have liability insurance and Affidavit Regarding Liability Insurance forms (LIC 282) were reviewed and in files.



Criminal Record Clearance: Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Safe Sleep: LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Per licensee does not administer medication.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/resources/child-care-centers/.

809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SAHU, SHIBANI
FACILITY NUMBER: 013423341
VISIT DATE: 08/01/2024
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MyChildCarePlan.org: Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law: During the exit interview, the licensee, Shibani Sahu confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care 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 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

CCLD Inspection Process: To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

No deficiency noted during today's visit. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights provided. Exit interview conducted and report was reviewed with the licensee, Shibani Sahu.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
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