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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700397
Report Date: 11/02/2022
Date Signed: 11/02/2022 11:50:59 AM

Document Has Been Signed on 11/02/2022 11:50 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:SHIVARKAR, SNEHALFACILITY NUMBER:
015700397
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Snehal ShivarkarTIME COMPLETED:
12:00 PM
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On November 2, 2022, Licensing Program Analyst (LPA) Simerjit Kaur arrived for an announced Pre-licensing inspection and met with the applicant Snehal Shivarkar. The home was toured with the applicant to conduct a health and safety inspection. Present during the inspection were applicant's husband Rupesh Shivarkar and 1 infant age child. Applicant states the hours of operation for day care will be Monday through Friday, 8:30am to 6:00pm.

The home is single story and consists of a kitchen with nook, dining room, living room, three bedrooms, two bathrooms, garage, front yard and backyard. The home is neat and clean with heating and ventilation for safety and comfort.
ON LIMIT AREAS (accessible to children in care):Living room/day care room, bathroom located on the left side of the hallway, green top of the backyard. The isolation area will be in the dining area located adjunct to day care room.
OFF LIMIT AREAS (not accessible to children in care): Kitchen with nook, dining room, all three bedrooms, 1 bathroom located in bedroom, front yard, both side yards of the backyard, and garage. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing Department, so that an inspection can be completed prior to changing an off-limits area to on-limits.

The outdoor play area will be the backyard, which has a fence surrounding the perimeter of the yard, and is free from defects or dangerous conditions. The applicant was advised to ensure that the both side gates remains closed while children are outdoors. There are ample age appropriate toys, which are observed to be safe, clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPA did not observe any hazardous materials on the premises. Medicine/Vitamins were stored in off-limits hallway closet.
Continued on LIC 809C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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: SHIVARKAR, SNEHAL
FACILITY NUMBER: 015700397
VISIT DATE: 11/02/2022
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The home has a fully charged 2A10BC fire extinguisher which is located in the kitchen pantry, working smoke detector located on ceiling in the day care room, carbon monoxide detector on the kitchen wall, telephone, and fully stocked first aid kit. There is also a child proof gate between the off-limits kitchen and living room/day room to prevent access to off limit areas. Per applicant, there are no firearms in the home.

The applicant’s pediatric CPR/First Aid is current, expiring on 7/23/2024. A copy of the property tax shows control of property. Applicant has Preventive Health and Safety Practices with Lead Poisoning Prevention. Applicant completed Mandated Reporter Training on 9/7/2022. The applicant has provided proof of the immunizations, which are required for daycare providers. Applicant was reminded that children are never to be left in a parked vehicle. Roster of the children must be properly maintained. A fire/disaster drill must completed at least every six months and must be documented. A packet of forms pertaining to the children’s files and facility files were reviewed, discussed, and copies were left with the applicant.
LPA discussed the safe sleep regulations with applicant 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. LPA also informed applicant 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, 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.


Continued on LIC 809C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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: SHIVARKAR, SNEHAL
FACILITY NUMBER: 015700397
VISIT DATE: 11/02/2022
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The applicant was 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 $500 per person, per incident. The applicant was reminded of the responsibility as a mandated reporter.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.


Effective August 1, 2003 California Law requires Family Child Care Home 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 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

This home is recommended for licensing on 11/2/2022. This report shall remain on file for 3 years. Exit interview conducted with Snehal Shivarkar. Copy of report provided.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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