313624899-4-24-2023-03-CC-KOWS-CR7PKM-20230424112322

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313624899
Report Date: 04/24/2023
Date Signed: 04/24/2023 11:23:32 AM

Document Has Been Signed on 04/24/2023 11:23 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	RATH, BHAGYASHREE		FACILITY NUMBER:	313624899
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/24/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Bhagyashree Rath - Applicant		TIME COMPLETED:	12:00 PM

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	Licensing Program Analyst (LPA) Katrina Owens met with applicant for a pre licensing inspection Present at time of inspection were applicant and her husband. The home is a 4 bedrooms, three bathrooms, living/dining area and kitchen. LPA toured the home inside and out, and reviewed forms for children's records. LPA explained about obtaining $300,000 liability insurance. She understands that until a policy is obtained, she must use the affidavit. Applicant has certificates of completion for 15 hours of health and safety training including CPR and First Aid with expiration date of 3/2025. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Applicant, Bhagyashree Rath, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA has provided the Applicant with the web site to enable access to all updated forms, requirements and changes. Applicant understands that she needs to notify licensing for any modification inside and out of the home. Off-limit areas include: Entire upstairs and Garage. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. Applicant stated there are no weapons in the home. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Hazardous cleaning compounds are inaccessible to children. Sharp utensils and Medications are inaccessible to children. There is no pool or bodies of water at the home. There are no pets at the home. Stairs are barricaded when children under age 5 years old are present. Hours of operation are 8:00 am to 5:00 pm and other hours as arranged. Continued on next page

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: RATH, BHAGYASHREE	FACILITY NUMBER: 313624899
	VISIT DATE: 04/24/2023

NARRATIVE

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LPA observed proof that applicant and staff/ volunteers have met the requirements of SB 792.

LPA observed that applicant has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com.

LPA gave applicant the Effects of Lead Exposure brochure.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.

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

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

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. LPA explained and gave a forms packet at time of inspection. LPA Owens explained the Maximum Capacity worksheet in detail at time of inspection.

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 platform Continued on next page.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: RATH, BHAGYASHREE	FACILITY NUMBER: 313624899
	VISIT DATE: 04/24/2023

NARRATIVE

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

Effective today 4/24/2023, applicant is license to serve up to either 8 children, two (2) of which must be at least 6 years of age and no more than two (2) may be infants; or 6 children, three (3) of which may be infants; or 4 infants only. Infants are children under the age of 2 years.

Exit Interview were conducted.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC809 (FAS) - (06/04)

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