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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700289
Report Date: 06/22/2022
Date Signed: 06/22/2022 02:00:36 PM

Document Has Been Signed on 06/22/2022 02:00 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:MODI, BHAVIKAFACILITY NUMBER:
015700289
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
06/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Bhavika ModiTIME COMPLETED:
02:15 PM
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On 6/22/2022 Licensing Program Analyst (LPA) Jaylena Miller met with licensee Bhavika Modi for an unannounced CASE MANAGEMENT inspection for an INCREASE OF CAPACITY to a large family childcare home. Present for the inspection were licensees fingerprint cleared husband and 5 daycare children were present at the time of the inspection.

The fire clearance for the increase of capacity was received and approved on 6/2/2022.

LPA toured the entire home and backyard for a health and safety inspection. The home is a duplex that consist of 3 bedrooms and 2.5 bathrooms, living room, kitchen and garage.
The On-limits areas are: The kitchen, living room and first bedroom on the right hand side in the hallway. The designated outdoor area will be the backyard that is fully fenced.
The Off-limits areas are: The garage, the master bedroom, two full bathrooms and the office area at the end of the hallway and will be made inaccessible to children by locked doors, safety gate and visual supervision.

LPA observed the home to have an acceptable amount of space, number of toys and furnishings that are neat, clean and age appropriate. The home is equipped with a 2A-10BC fire extinguisher that is fully charged, working smoke detector, and working carbon monoxide detector. There is a working telephone in the home. Per licensee there are no firearms on the premises. There are no pools, hot tubs, or other bodies of water at the home. All poisons, cleaning solutions and medications are inaccessible to children. Per the fire clearance inspection, the garage is off limits to children, LPA Miller reminded licensee and confirmed the garage would not be used as mentioned per the fire clearance.

This home is recommended for a large family childcare home license as of 6/22/2022. There are no deficiencies cited. This report shall remain on file for 3 years. Exit interview conducted with Licensee and LPA provided licensee with a copy of notice of site visit and a copy of this report.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2022
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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