Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406699
Report Date: 04/27/2016
Date Signed: 04/27/2016 11:00:45 AM

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SAFARI KID - LITTLE HEARTSFACILITY NUMBER:
073406699
ADMINISTRATOR:RINKU THAKURFACILITY TYPE:
850
ADDRESS:500 BOLLINGER CANYON WAY #A10TELEPHONE:
(925) 968-9721
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY:30CENSUS: 28DATE:
04/27/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Rinku ThakurTIME COMPLETED:
11:20 AM
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(1) Licensing Program Analyst, Jason Jang made an annual random visit to the facility. I met with the Site Director, Rinku Thakur. The classroom and bathrooms were inspected in today's visit. The snack menu, sign in sign out sheet, first aid kit, and fire drill log book were all reviewed and found to be complete. Children and staff files were reviewed. Staff had a current cpr and first aid certificate. This facility provides Incidental Medical Services-IMS. LPA reviewed the storage of medication and equipment and supplies, and reviewed children’s, personnel, and administrative records. LPA discussed the need to update the centers plan of operation to reflect IMS plan. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173. · Exit interview conducted. Licensee was provided a copy of their appeal rights. Assembly Bill 633 Fact Sheet was given and discussed with the licensee. Notice of site visit was posted at the time of the inspection, and must remain posted for 30 days.

No deficiencies were cited.

SUPERVISOR'S NAME: Zakiya AliTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2016
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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