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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700293
Report Date: 01/20/2022
Date Signed: 01/20/2022 11:07:54 AM

Document Has Been Signed on 01/20/2022 11:07 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:PATEL, SHIRALIFACILITY NUMBER:
015700293
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/20/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shirali PatelTIME COMPLETED:
11:30 AM
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On 01/20/2022 at 9:30am, Licensing Program Analyst (LPA) Christina Uribe met with applicant Shirali Patel for the purpose of conducting an announced pre-licensing inspection. Present during today’s inspection is the applicant & applicant’s 3-year-old daughter. The home was toured for a health and safety inspection.

On-Limit Areas: Living Room, Family Room, Kitchen, Dining Area, Bedroom #2, Bedroom #3, Bathroom #1, & Backyard.

Off-Limit Areas: Master Bedroom, Master Bathroom, Laundry Room, Garage, Bedroom #1 & Office (Room #5)

The house is a single story home consisting of 4 bedrooms, 2 bathrooms, an office, living room, family room, kitchen, dining area, laundry room, garage, & backyard. The off-limit areas are made inaccessible by child-proof knob covers, closed/locked doors, & safety gates. The isolation area is in bedroom #2. Entrance into the home is the connected living room, family room, kitchen, & dining area. The office is located to the left of the entrance into the home. The hallway leads to the garage through the laundry room, bedroom #1, bathroom #1, bedroom #2, bedroom #3, master bedroom & bath. The front living room has a fireplace located opposite of the front door which is inaccessible by a cover. The backyard is fully fenced with no bodies of water, no play structures, and free from hazardous materials or objects.

There are ample age-appropriate toys that appear to be safe and in good condition. The home is equipped with a fully charged 3A40BC fire extinguisher, functional carbon monoxide detector, smoke detector, & telephone. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

Per applicant, there are no firearms or pets in the home during today’s inspection. The applicant is in compliance with the immunization laws which pertain to all childcare providers. All required forms are posted and visible for public review.

***Continued on LIC809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/20/2022
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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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: PATEL, SHIRALI
FACILITY NUMBER: 015700293
VISIT DATE: 01/20/2022
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Applicant completed and received certificates for Mandated Reporter Training & Pediatric CPR/First-Aid Training and was reminded of their responsibility to renew each training every two years. Applicant's CPR/First-Aid Certification expires on 11/12/2023 & her Mandated Reporter Training Certificate expires on 10/21/2023.

This facility plans on providing Incidental Medical Services (IMS). For IMS information see Evaluator Manual – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. 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

LPA informed applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Baby bouncers & drop-down cribs are not allowed at the daycare facility. Roster of children & their records must be properly maintained & available for review at all times. A fire/disaster drill must be performed and recorded every 6 months. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to the Community Care Licensing. The licensee was provided information regarding the effects of Lead Exposure and testing requirements (Assembly Bill 2370).

Applicant 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.

***Continued on LIC809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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: PATEL, SHIRALI
FACILITY NUMBER: 015700293
VISIT DATE: 01/20/2022
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

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.

This home is recommended for Licensure on 01/20/2022. This report shall remain on file for 3 years. Exit interview was conducted with applicant, Shirali Patel.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
LIC809 (FAS) - (06/04)
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