015700482-8-29-2023-52-CC-BPLY-CV6NTT-20230829104515

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700482
Report Date: 08/29/2023
Date Signed: 08/29/2023 10:45:25 AM

Document Has Been Signed on 08/29/2023 10:45 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	DONGAONKAR, SWATI		FACILITY NUMBER:	015700482
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	08/29/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:47 AM
MET WITH:	Swati Dongaonkar- Licensee		TIME COMPLETED:	10:55 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/29/23 at 8:47am, Licensing Program Analyst Briana Plumboy, met with applicant Swati Dongaonkar for an ANNOUNCED PRE LICENSING INSPECTION. Present for this visit was licensees fingerprint cleared and associated husband Pradyumna Dongaonkar. The home was toured to conduct a Health and Safety Inspection. The applicant plans to operate Monday through Friday from 8:00am until 6:00pm. The home is single story. The home consists of a living room, family room, half bathroom located in the family room, kitchen, 2 bedrooms, and master bedroom with master bathroom. The home has ventilation for safety and comfort. The OFF LIMIT AREAS are are the living room, kitchen, 2 bedrooms, and master bedroom with master bathroom which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the family room (designed as a childcare), half bathroom in the family room, and the fenced backyard. The ISOLATION AREA will be an area in the family room. Outdoor play area will be fenced backyard. There are 2 sheds located in the backyard which are off limits to children in care. There are child safety gates present today which make the areas around the shed inaccessible during today's inspection. The parents enter the childcare through the gate which leads to the backyard and applicant is aware at all times when the gate opens, it should be monitored and closed as soon as the person enters or exits. There are toys that are safe and appeared to be clean during today's inspection. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items which could be accessible during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working combined smoke detector & carbon monoxide detector, and working telephone. The applicant’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 1/14/25. The applicant completed and received a certificate in mandated reporter training See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: DONGAONKAR, SWATI	FACILITY NUMBER: 015700482
	VISIT DATE: 08/29/2023

NARRATIVE

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on 5/8/22. The applicant is in compliance with new immunization law which pertains to day care providers. The water heater is located behind the wall in the half bathroom. Per applicant, there are no firearms in the home. A copy of the lease was reviewed and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed.

The applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The applicant was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

Applicant is 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 $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: DONGAONKAR, SWATI	FACILITY NUMBER: 015700482
	VISIT DATE: 08/29/2023

NARRATIVE

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Family Child Care Homes Applicant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
During the exit interview, the applicant Swati Dongaonkar confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to 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-andresources/safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] 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.

Subscribe to CCLD important information - Child Care Centers and Family Child Care Homes: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Swati Dongaonkar.
This home is recommended for licensing on 8/29/23. This report shall remain on file for 3 years.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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