015700236-8-17-2021-52-CC-CCHS-C5Z2GV-20210817172345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700236
Report Date: 08/16/2021
Date Signed: 08/17/2021 05:24:00 PM

Document Has Been Signed on 08/17/2021 05:24 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:	MEHRA, SUMEDHA & TARUN		FACILITY NUMBER:	015700236
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/16/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Tarun & Sumedha Mehra		TIME COMPLETED:	04:15 PM

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08/16/2021, at approximately 1:30pm, Licensing Program Manager Chandra Charles, met with Applicants Sumedha & Tarun Mehra, to conduct a Pre – Licensing site inspection of their home. Present at the home and during the inspection was the applicants in-laws. The Health and Safety inspection was conducted by the Chandra Charles, (LPM) and both applicants.

The applicants home is a two story home with 4 bedrooms, a loft and 2.5 bathrooms. The home consists of on the first level a two car garage, living room, family room, dining room, kitchen, bathroom and back door patio exit to the backyard area. On the second level – master bedroom with a master bathroom, 3 additional bedrooms, additional upstairs bathroom, laundry room, and loft.

Applicants have requested the entire second level of the home, and the garage be ‘Off Limits’. The ‘On Limits’ areas which the day-care children will have access to is the entire first level of the home.

The home has central heating with ventilation for safety and comfort. LPM observed and heard properly functioning dual carbon monoxide / smoke detector, and a fully charged 2A-10-BC fire extinguisher. LPM, reviewed a mortgage statement that shows applicants have control of the property.

Applicants have a barrier gate at the bottom of the staircase to prevent access to the second level of the home.

SUPERVISORS NAME: Anika Evans
LICENSING EVALUATOR NAME: Chandra Charles
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

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: MEHRA, SUMEDHA & TARUN	FACILITY NUMBER: 015700236
	VISIT DATE: 08/16/2021

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The Backyard is large, and completely fenced. It is divided into three sections. The left side and the right sides of the backyard areas are 'Off limits' with a barrier gate/ fence to prevent access to those areas. The Center area of the backyard will be ‘On limits’ to the day-care children. The backyard play area is free from defects or dangerous conditions. There are age appropriate new toys for the children to utilize. There are no pools, hot tubs or any other bodies of water on the premises. All hazardous materials and toxins are out of the reach of children.

The applicants Preventive Health and Safety training are completed, CPR and First Aid certificates are current and will expire on 11/21/2022. Both applicants completed the Mandated Reporter training and both applicants are following immunization law as it pertains to all day-care providers. Per applicant, there are no firearms in the home. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. (LPM) discussed the Safe Sleep practices.

Applicants are 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. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov and for day care updates visit www.myccl.gov.

This home is recommended for licensure. This report shall remain on file for 3 years. Exit interview conducted.

SUPERVISORS NAME: Anika Evans
LICENSING EVALUATOR NAME: Chandra Charles
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

LIC809 (FAS) - (06/04)

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