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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500472
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:23:26 PM

Document Has Been Signed on 08/26/2021 01:23 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:SAPRE, SARIKAFACILITY NUMBER:
394500472
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/26/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Sarika SapreTIME COMPLETED:
01:00 PM
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On August 26, 2021 Licensing Program Analyst (LPA) Stacey Williams met with Applicant Sarika Sapre for the purpose of a Pre-Licensing inspection. LPA and Applicant toured the entire two-story home. Applicant’s husband and daughter were present in the home during the inspection. The home consists of 4 bedrooms, 3 bathrooms, kitchen, living room area, garage and fenced backyard. Off limit areas will consist of the entire upstairs, kitchen and the garage.


Applicant owns the home. LPA obtained a copy of documentation to show control of property. Applicant's CPR and First aid certification was verified. LPA reviewed required forms for children's records including licensing forms and immunization records. Applicant understands the poster will remain visible for parents to review. Applicant will place COVID-19 posters throughout the home. New regulations were reviewed including safe sleep concepts and requirements for infants. LPA provided Applicant with the updated safe sleep PIN 20-24-CCP and a blank Infant Individual Sleeping Plan (LIC9227) for her records. Lead exposure and prevention was discussed as well as vaccination requirements for staff and children, and smoking prohibition. 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

There were no bodies of water at the home. The backyard has gravel. Applicant stated that she will notify LPA once the backyard is landscaped.

Kitchen cabinets are latched, and cleaning compounds, knives and medications are inaccessible to children.

(report continued next page, LIC 809-C)
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: SAPRE, SARIKA
FACILITY NUMBER: 394500472
VISIT DATE: 08/26/2021
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LPA observed a 2A10BC fire extinguisher, an operational smoke and carbon monoxide detector in the home that meet regulatory standards. LPA advised the applicant that it there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

Applicant has completed the required AB1207 Mandated Reporter training. Applicant understand that the training must be completed once every two years, training is accessible at www.mandatedreporterca.com.

Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months. Applicant is informed all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance.

Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Licensee was informed about the Provider Information Notices (PINs) on CCLD website.


This facility evaluation report was reviewed and discussed with the Applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. COVID-19 Updated guidance for childcare programs and providers as well as best practices concerning social distancing and mask requirements for adults and children over the age of 2 years old was discussed with the Applicant. COVID-19 Outbreak guidance was discussed .Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA advised Applicant of their responsibility to stay current in regard 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.


As of today 8/26/2021, Applicant is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
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