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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500745
Report Date: 12/14/2023
Date Signed: 12/14/2023 01:47:38 PM

Document Has Been Signed on 12/14/2023 01:47 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DUBEY, SHIKHAFACILITY NUMBER:
394500745
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
12/14/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Shikha DubeyTIME COMPLETED:
02:00 PM
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On 12/14/2023 at 10:00 AM, Licensing Program Analyst (LPA) Tiffanie Diep met with Licensee Shikha Dubey for the purpose of an unannounced annual inspection and to increase the facility’s capacity from a small Family Child Care Home to a large Family Child Care Home, and Licensee guided LPA on a tour of the home. A fire clearance was granted by South County Fire Authority Community Risk Reduction on 11/17/2023. Licensee provided proof of control of property. LPA observed six children present in the home with Licensee and their assistant. Licensee's operating hours are Monday through Friday from 8:30 AM to 3:30 PM. LPA verified that annual fees are current.

All individuals subject to a criminal record review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA reviewed five children's files, and LPA observed emergency information and required immunization records were on file. LPA did not observe a roster and documentation that a fire drill is conducted at least once every six months. LPA discussed the requirements to maintain a current roster and to conduct and document fire and disaster drills. LPA verified Licensee's immunization records were available in the facility file. Current Mandated Reporter Training certificate was verified and expires on 06/21/2024. LPA informed Licensee that certifications for all personnel are to be AB1207 compliant. Current EMSA pediatric CPR and first aid certification was verified and expires on 07/30/2024.

Continues on 809-C
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DUBEY, SHIKHA
FACILITY NUMBER: 394500745
VISIT DATE: 12/14/2023
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Continued from 809 (Page 2)

A health and safety inspection of the home’s interior and exterior was conducted in all areas accessible to children. The off-limits areas in the home include the living room, dining room, entire second floor, and garage. Licensee acknowledged that children may never enter the off-limits areas. During the inspection, Licensee requested to make the kitchen on limits. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed cleaners stored underneath the kitchen sink and inaccessible to children in care. The kitchen will be made on-limits effective today, December 14, 2023. LPA observed stairs to the second floor barricaded by a baby gate. LPA observed the required postings and a working phone. LPA observed a 3A40BC fire extinguisher meets regulations and verified both smoke and carbon monoxide detectors were functional. LPA observed a restroom and verified that toxic and hazardous items were inaccessible to children in care. LPA observed the family room/day care room with age-appropriate toys for children. Licensee stated there are no weapons in the home. LPA did not observe a fireplace in the home. The outdoor play area was inspected and is surrounded by wooden and chain link fences. LPA walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. LPA observed a play structure and trampoline in the backyard. LPA did not observe bodies of water on the premises.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee 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. LPA discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months. LPA reminded Licensee to maintain a copy of the Individual Sleeping Plan (LIC 9227) for infants under 12 months.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DUBEY, SHIKHA
FACILITY NUMBER: 394500745
VISIT DATE: 12/14/2023
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Continued from 809-C (Page 3)

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. 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 https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, 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.

A license for a large Family Child Care Home is granted effective today, December 14, 2023. The facility is approved to serve a capacity of 12 children (when there is an assistant present) with no more than 4 infants, or up to 14 children with no more than 3 infants, 1 child enrolled in transitional kindergarten or above, and 1 child at least age 6. Infants are children under the age of 2. Without an assistant present, Licensee must follow regulations for a small Family Child Care Home.

There were no deficiencies cited at this time. An exit interview was conducted and report was reviewed with the licensee, Shikha Dubey. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023
LIC809 (FAS) - (06/04)
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