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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700144
Report Date: 06/29/2022
Date Signed: 06/29/2022 12:08:32 PM

Document Has Been Signed on 06/29/2022 12:08 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:SHAH, BHAVNABENFACILITY NUMBER:
015700144
ADMINISTRATOR:SHAH, BHAVNABENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 766-6619
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Bhavnaben ShahTIME COMPLETED:
12:20 PM
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On June 29, 2022, 9:15am Licensing Program Analyst (LPA) April Wright conducted a Unannounced Annual Inspection and met with Licensee Bhavaben Shah. Present during the inspection was the Licensee fingerprint clear and associated husband Sandip Shah and 1 volunteer staff member. Licensee husband Sandip Shah assisted during the inspection. The home was toured to conduct a Health and Safety Inspection. The hours of operation are Monday through Friday from 8:30AM to 6:00PM.

This is a single story home with 1 master bedroom/bathroom, 2 bedrooms, 1 additional bathroom, living room, day care room, sun room, kitchen, garage and backyard. The home was inspected for safety, comfort, cleanliness, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children were not observed.

On Limit Areas: day care room, sun room, bathroom located right side of the hallway, right side of the backyard. The outdoor play area is free from defects or dangerous conditions. There are ample age appropriate toys that are safe and clean.

Off limit Areas: kitchen, living room located right side of hallway, 1 master bedroom/bathroom located at the right side of the hallway, 2 bedrooms located left side of the hallway, garage, both sides and left side of the backyard including garden area adjacent to the sun room, which will be inaccessible by closed and/or locked doors and visual supervision.

The ISOLATION AREA for sick children will be living room area.

There are no pools, hot tubs or any other bodies of water on the premises today. 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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: SHAH, BHAVNABEN
FACILITY NUMBER: 015700144
VISIT DATE: 06/29/2022
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Records review of staff and children were conducted. Upon review of staff records, LPA observed that Volunteer Sumitha Thilakkumar was not associated with the facility nor fingerprint cleared. Licensee spouse Sandip stated that volunteer Sumitha had new LiveScan completed on 4/12/2022. Volunteer was previously employed by Young Explorers. LPA advised licensee that due to fingerprints not being cleared, Volunteer Sumthia has to leave facility immediately. Volunteer Sumthia can return to home once fingerprint transfer clearance has been received they are associated to facility.

Licensee Health and Safety Training is completed and CPR and First Aid certificate is current and expires on 6/4/24 . The Licensee are in compliance with new immunization law which pertains to day care providers. The Licensee is in compliance with the Mandated Reporter Training course requirement and will renew before 11/20/2022. Per licensee, there are no firearms in the home. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The home has secured child safety outlet covers. The posting broad is in the main entrance for required postings.



Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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.

Incidental Medical Services (IMS) policy was discussed. No IMS is provided by the licensee. 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
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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: SHAH, BHAVNABEN
FACILITY NUMBER: 015700144
VISIT DATE: 06/29/2022
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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.

There was a Technical Violation was received for fingerprint clearance on Volunteer Sumitha see LIC 9102 for details. This report shall remain on file for 3 years. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days.

Exit interview conducted with Licensee spouse Sandip Shah and a copy of this report and appeal rights provided.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
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