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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700203
Report Date: 06/14/2023
Date Signed: 06/14/2023 03:57:05 PM

Document Has Been Signed on 06/14/2023 03:57 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:MEHROTRA, DEEPALIFACILITY NUMBER:
075700203
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
06/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Deepali MehrotraTIME COMPLETED:
04:05 PM
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On June 14, 2023 at 3:35pm, Licensing Program Analyst (LPA) arrived unannounced for a case management inspection. LPA met with licensee Deepali Mehrotra. Present were two infants, three preschool age children and the licensee's school age son.

The purpose of today's inspection was for LPA to check the new play structure licensee has installed in her backyard. LPA observed the play structure to be safe and properly anchored to the ground with adequate cushioning material to absorb falls. The play structure is approved today for day care use.

No deficiencies were cited today.

Exit interview conducted with licensee Deepali Mehrotra. A Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2023
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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