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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700293
Report Date: 02/01/2023
Date Signed: 02/01/2023 01:43:47 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/01/2023 01:43 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:PATEL, SHIRALIFACILITY NUMBER:
015700293
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Shirali PatelTIME COMPLETED:
01:55 PM
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On February 1, 2023, Licensing Program Analyst (LPA) Simerjit Kaur arrived at facility for an UNANNOUNCED REQUIRED 1 YEAR ANNUAL INSPECTION and met with Licensee Shirali Patel. Licensee stated that she is working outside the home at this time and she would like to be placed on inactive status.

Licensee completed LIC 9211 inactive status request and gave it to LPA. LPA discussed that licensee could cancel the inactive status by calling or in writing if she wishes to provide child care or she may extend the inactive status in the future.
LPA advised the conditions of being on Inactive Status. Licensee has agreed to the terms and conditions. This form was approved by the Licensing Program Analyst.

LPA advised within 10 business day the licensee will be sent a new license which will reflect her inactive status.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list. 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.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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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