435700319-6-29-2021-52-CC-MESA-C4FUXB-20210629155804

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700319
Report Date: 06/29/2021
Date Signed: 06/29/2021 03:58:11 PM

Document Has Been Signed on 06/29/2021 03:58 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 1102
OAKLAND, CA 94612

FACILITY NAME:	SAH, NIDHI		FACILITY NUMBER:	435700319
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	06/29/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:21 PM
MET WITH:	Nidhi Sah		TIME COMPLETED:	04:00 PM

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On Tuesday, June 29, 2021 2;21 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Case Management Visit for an Capacity Increase Application. LPA met the Licensee Nidhi Sah. Present on this visit were the Licensee's spouse, Licensee's 2 preschool children, 2 infant and 4 preschool children from different family. Facility operates from Monday to Friday from 8:30 am to 6pm.

The home was toured to conduct a Health and Safety Inspection. The home is neat and clean with heating and ventilation for safety and comfort. The on limits area are the foyer, living room, dining area, kitchen, hallway bathroom and fenced backyard. The off limits are all the bedrooms, garage and front yard which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision.

The designated isolation area for a child who becomes ill while in care is the foyer area. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. The fireplace is screened to prevent access by children. Per licensee, there are no firearms in the home.

The licensee conducts and documents fire and disaster drills twice a year with the last one conducted.
Licensee owns the house and has childcare liability insurance with (INSURANCE COMPANY AND DETAILS). The facility carries childcare liability insurance. The licensee conducts Fire and Disaster Drill and last drill was on February 2021.

Licensee stated that received a Covid 19 Vaccination in April 2021.

See LIC 809-C for continuation

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SAH, NIDHI	FACILITY NUMBER: 435700319
	VISIT DATE: 06/29/2021

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Continuation....

Licensee is reminded that all assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. To file a complaint regarding a state licensed community care facility or child care facility, call Community Care Licensing Division Complaint Hotline 1-844-538-8766 or email letusno@dss.ca.gov.

Licensee is encouraged to visit the Department’s website to access resources for Providers, Title 22 Regulations, online option to pay Annual License fee, all forms can be downloaded, Child Care Resource & Referral Network (R&Rs) and more information at https://cdss.ca.gov/inforesources/child-care-licensing. This website link https://ccld.childcarevideos.org/ includes videos that explain licensing topics relevant to families and licensed child care providers.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

For licensing updates, advised Licensee to email childcareadvocatesprogram@dss.ca.gov and request to be added to the email list.

There are no deficiencies cited on this visit. The facility is granted for a Large Family Child Care Home License effective today.

This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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 1102
OAKLAND, CA 94612

FACILITY NAME: SAH, NIDHI	FACILITY NUMBER: 435700319
	VISIT DATE: 06/29/2021

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Continuation......
The licensee CPR and First Aid certificate and expires on 07/11/2022. The licensee completed the Mandated Reporter General Training and Child Care Providers training online at https://mandatedreporterca.com/ on 04/26/2021. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Immunization. The licensee is in ratio today.

Licensee stated that she does transport children at this time. Licensee has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions and all vehicle occupants must be secured in an appropriate restraint system.

LPA Estoesta discussed, provided copies of New Safe Sleep Brochure, Lead Poisoning Facts Flyer andto the licensee. For more information, please follow the links https://cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, https://cdss.ca.gov/inforesources/child-care-licensing/water-testing-information and https://www.chp.ca.gov/Programs-Services/Programs/Child-Safety-Seats.

Individual Medical Services (IMS) policy was discussed. 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: https://www.ada.gov/childqanda.htm.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.
See LIC 809-C for continuation

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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