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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700289
Report Date: 11/01/2021
Date Signed: 11/01/2021 10:07:00 AM

Document Has Been Signed on 11/01/2021 10:07 AM - 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:MODI, BHAVIKAFACILITY NUMBER:
015700289
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Bhavika ModiTIME COMPLETED:
10:30 AM
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On 11/01/2021, at approximately 8:30am, Licensing Program Analyst (LPA) Kelly Phan and Licensing Program Manager (LPM) Jason Jang met with applicant Bhavika Modi and her fingerprinted and associated husband Paresh Modi for an announced pre-licensing visit to conduct a health and safety inspection of their home. Hours of operation will be Monday to Friday from 8:30am to 6pm.

The applicants home is a duplex with their two children between the ages of 7 and 14 years old. The home is clean and orderly and does not consist of any dangerous or hazard items. The areas of the daycare are part of the kitchen, full backyard, living room, and bathroom #1. The off-limit areas are garage, bathroom #2, bedroom #1, bedroom #2, and bedroom #3, hallway #1, and hallway #2. Applicant will put a gate, locks, and have child-proof door knobs to make the areas inaccessible to children. Per applicant, there is no fireplace and stairs present in the home.

The home has central heating with ventilation for safety and comfort. LPA and LPM observed and heard properly functioning dual carbon monoxide/smoke detector, and recommended applicant to obtain appropriate 2A-10-BC fire extinguisher.

Approximately 8:50am, LPA and LPM inspected the backyard that is completely fenced. Per applicant, the full 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 house is own by the applicant and her husband.

The applicants Preventive Health and Safety training are completed, CPR and First Aid certificates are current. 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 or pets 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 not recommended for licensure. This report shall remain on file for 3 years. Exit interview conducted.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
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: MODI, BHAVIKA
FACILITY NUMBER: 015700289
VISIT DATE: 11/01/2021
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CONTINUE LIC 809-C
The applicants Preventive Health and Safety training are completed, CPR and First Aid certificates are current. 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 not recommended for licensure. This report shall be remain on file for 3 years. Per applicant, she would purchase appropriate fire extinguisher to make the home sufficient for obtaining license. LPA has provided email to send photo of correct fire extinguisher.

Exit interview conducted. Appeal rights were given.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC809 (FAS) - (06/04)
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