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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700144
Report Date: 08/16/2024
Date Signed: 08/16/2024 11:32:51 AM

Document Has Been Signed on 08/16/2024 11:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SHAH, BHAVNABENFACILITY NUMBER:
015700144
ADMINISTRATOR/
DIRECTOR:		SHAH, BHAVNABENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 766-6619
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
08/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH: Bhavnaben ShahTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On August 16th, 2024 at approximately 9:15am Licensing Program Analyst (LPA) April Wright arrived for an Annual/Random Inspection and met with Licensee Bhavnaben Shah. Present during inspection were ten (10) children (8 preschool/2 infants) and the licensee's fingerprint cleared assistant, spouse and daughter. LPA toured the home to conduct a health and safety inspection. Hours of operation are 8:30am - 6:00pm Monday through Friday.

The single story home consists of 3 bedrooms, 2 bathrooms, living room, family room, sun room, kitchen, dining area, backyard and garage. The home was neat and orderly, with heating and ventilation for safety and comfort of children in care. There are age appropriate toys that were inspected and in good condition. The isolation area is in the living room which is a section away from other children in care. The backyard is completely fenced and LPA observed it to be in good repair, free of damage or hazardous conditions. LPA observed and Licensee confirmed that are no toxins, medicines, cleaning products or hazardous materials visible during today's inspection and were made inaccessible to children in care. The fireplace is barricaded and has glass door which is locked, and is secured by child safety gate. LPA observed glass door to have no signs of damage or defects and it is inaccessible to children in care.

On Limit Areas: Family room/Sun room (Day care rooms #1 and #2), bathroom #1(located down the hallway to the right) and right side of the backyard.
Off limit Areas: Living room(located right side of entry to the home used only for the isolation area), dining area, all three (3) bedrooms, kitchen and garage, remaining portion of backyard and garden area (adjacent to the sun room). The off limits areas will be made inaccessible by closed and/or locked doors, child safety gates and visual supervision. The home has a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, and working telephone. LPA observed and Licensee confirmed that there are no pools, hot tubs or any other bodies of water present in the home. LPA observed and licensee confirmed there are no firearms, weapons or pets in the home. See LIC809C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SHAH, BHAVNABEN
FACILITY NUMBER: 015700144
VISIT DATE: 08/16/2024
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All individuals subject to criminal record review have a clearance or exemption and have been associated to this FCCH. LPA requested and reviewed the files of ten (10) children in care. The children's files contained, Parents rights, medical consent forms, identification and emergency contacts. The children's roster was reviewed and a copy was obtained. The licensee conducts fire/disaster drills twice a year and the last was conducted on 4/2/2024. Licensee has current Mandated reporter training which was completed on 11/9/2024, assistant on 4/24/2023 and CPR/First aid certificates that expire 5/2026. Licensee is in ratio today. Licensee was reminded by LPA that high/low chairs are for eating purposes only and should not be used as a form of restraint. All required forms are posted and visible for public viewing.

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 5 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 discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP . 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/resources/child-care-centers/.

See LIC809C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SHAH, BHAVNABEN
FACILITY NUMBER: 015700144
VISIT DATE: 08/16/2024
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During the exit interview, the Licensee Shah, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee was informed of the MyChildCarePlan.org website; 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 notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Bhavnaben Shah.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC809 (FAS) - (06/04)
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