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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700293
Report Date: 10/04/2023
Date Signed: 10/04/2023 01:30:24 PM

Document Has Been Signed on 10/04/2023 01:30 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:PATEL, SHIRALIFACILITY NUMBER:
015700293
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/04/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Shirali PatelTIME COMPLETED:
01:40 PM
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On October 4, 2023, Licensing Program Analyst Simerjit Kaur conducted a case management inspection with licensee Shirali Patel. The purpose of the inspection was to change the license status from inactive to active status. Present for the inspection was licensees mother-in-law Daxaben Patel, who does not have a fingerprint clearance and lives in the home, and no children in care. The home was toured with the licensee to conduct a health and safety inspection.

Licensee has option to remain on inactive status until Daxaben Patel obtains a fingerprint clearance. Licensee stated she will remain on inactive status until her mother-in-law retains a fingerprint clearance. LPA Kaur will return for an inspection to revert her status back to active status.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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