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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201056
Report Date: 01/29/2023
Date Signed: 01/29/2023 02:21:36 PM

Document Has Been Signed on 01/29/2023 02:21 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. 310
OAKLAND, CA 94612
FACILITY NAME:SHARMILA CARE SERVICES 2 LLCFACILITY NUMBER:
019201056
ADMINISTRATOR:SINGH, SHARMILAFACILITY TYPE:
735
ADDRESS:651 TINA WAYTELEPHONE:
(510) 301-4558
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 6CENSUS: 3DATE:
01/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Tara Shukla, CaregiverTIME COMPLETED:
02:25 PM
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On 01/28/2023 at 1:15PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Tara Shukla, Caregiver and explained the purpose of the visit. Administrator, Janice Narayan-Singh arrived at 1:45PM.

Upon entry, LPA's temperature was not checked. LPA observed a screening station, but not any COVID signs. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, back yard, kitchen, and garage. LPA did not observe cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap, paper towel, and hand washing posters. LPA recommended step on or automatic trash cans for kitchen and bathrooms. Hot water temperature in the shared clients’ bathroom was measured at 108.1 degrees Fahrenheit. Fire extinguisher purchased 12/5/2022. There is a minimum of 7-day non-perishables and 2-day perishables foods. Smoke/carbon monoxide detector operable.

During record review, LPA observed facility has a copy of the Mitigation plan on file. LPA observed PPE and paper supplies are sufficient.

LPA requested the following documents be submitted to CCLD by 2/6/2023:
  • Facility roster


Continued on LIC809C.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2023
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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: SHARMILA CARE SERVICES 2 LLC
FACILITY NUMBER: 019201056
VISIT DATE: 01/29/2023
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Continued from LIC809.
  • Personnel record (LIC500).
  • Updated emergency disaster plan (LIC610D)
  • Designation of facility responsibility (LIC308)


No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2023
LIC809 (FAS) - (06/04)
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