015700264-7-17-2023-52-CC-RHAR-CTTQGD-20230717120921

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700264
Report Date: 07/17/2023
Date Signed: 07/17/2023 12:09:30 PM

Document Has Been Signed on 07/17/2023 12:09 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:	PAREKH, CHETNABEN		FACILITY NUMBER:	015700264
ADMINISTRATOR:	PAREKH, CHETNABEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 218-2367
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 10	DATE:	07/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Chetna Parekh		TIME COMPLETED:	12:15 PM

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On July 17, 2023 at approximately 9:00am am Licensing Program Analyst (LPA) Russ Haderer arrived unannounced for an annual inspection for health and safety. Present for today’s inspection was the licensee, her fingerprint and TB cleared helper 10 children in care: 2 infants; 5 two years old; 3 three years old. The facility is in ratio today. Hours of operation remain Monday-Friday, 8:30AM to 5:30PM.

The facility is a single story 3-bedroom, 2 bath home, and attached studio ADU (formerly the 2-car garage). The home is owned by the licensee and contains a dining room, kitchen, living room three bedrooms and two bathrooms, an enclosed (fenced) back and side yard areas and a separate courtyard area between the living room and one bedroom and a small driveway area in the front of the home. The home is neat and clean with heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be dining room area away from the other children in care.

On-limit-areas include: Living room (day care area), kitchen, dining room, bedroom attached to the courtyard (for napping) and the main house bathroom, the courtyard area and locked backyard area. The exterior gate has a padlock. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Off-limit-areas include: Master bedroom with attached master bathroom, second bedroom next to the master bedroom, studio ADU (formerly an attached 2-car garage) and driveway area of the front yard. The off-limit areas will be inaccessible by closed and/or locked doors, and/or by child supervision.

Licensee has ample age-appropriate toys and learning materials. The home has a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors (tested and functioning), and a working telephone. The disaster drill log showed the last drill conducted was completed on January 25, 2023.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

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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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: PAREKH, CHETNABEN	FACILITY NUMBER: 015700264
	VISIT DATE: 07/17/2023

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The licensee’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 01/22/2024, helper CPR expires on 12/10/2024. The licensee certificate in mandated reporter training (verified AB1207), expired on 05/09/2023. Helper’s Mandated Reporter is not completed, a technical advisory was issued, a technical violation was issued. Helper needs to complete the personnel record (LIC501), employee rights (LIC9052) and statement acknowledging requirement to report child abuse (LIC9108) – See LIC809D for deficiency. The licensee is in compliance with the immunization laws which pertains to day care providers, helper’s immunization records were not available, see LIC809D for deficiency.

LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years; CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

There is a fireplace in the living room that is blocked with heavy furniture to prevent children’s access. Per licensee, there are no firearms in the home. The licensee does not carry liability insurance, signed parent acknowledgement of this is in each child’s file. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. Child-proof doorknob covers for the ADU door access, the master bedroom and second off-limits bedroom.

Children’s files were reviewed and all were found to be complete and in good order. Infant Safe Sleep Plans (LIC9227) present and signed for all infants under 12 months, sleep logs maintained, in place and available for all infants up to 24 months.

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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

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: PAREKH, CHETNABEN	FACILITY NUMBER: 015700264
	VISIT DATE: 07/17/2023

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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/childqanda.htm

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/inspection-process.

There were 2 deficiencies issued today, see LIC 809D.

- Licensee’s Helper must complete forms LIC501; LIC9052; LIC9108

- Licensee’s helper needs to provide immunization records for measles, pertussis and flu shot

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

**Please see LIC 9102 for Advisory Notes.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Chetna Parekh.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/17/2023 12:09 PM - It Cannot Be Edited

Created By: Russell Haderer On 07/17/2023 at 11:41 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PAREKH, CHETNABEN	FACILITY NUMBER: 015700264
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that licensee helper needs to fill out, sign and date forms LIC501; LIC9052; and LIC9108 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/04/2023
	Plan of Correction
1 2 3 4	Licensee to collect all required personnel forms for all assistants, helpers and volunteers and keep copies in facility files for LPA review.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that only partial immunization records for helper were available in soft copy form which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/04/2023
	Plan of Correction
1 2 3 4	Licensee to collect all forms for all assistants, helpers and volunteers and keep copies in facility files for LPA review.

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:

Chandra Charles

LICENSING EVALUATOR NAME:

Russell Haderer

LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

LIC809 (FAS) - (06/04)

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