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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420878
Report Date: 03/27/2023
Date Signed: 03/28/2023 11:20:38 AM

Document Has Been Signed on 03/28/2023 11:20 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:CHHATRAPATI, KOMALFACILITY NUMBER:
013420878
ADMINISTRATOR:CHHATRAPATI, KOMALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 314-5945
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Komal ChhatrapatiTIME COMPLETED:
03:30 PM
NARRATIVE
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On March 27th, 2023 @ 1:30pm, Licensing Program Analyst (LPA) April Wright met with licensee Komal Chhatrapati for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit were 11 preschool children, and the licensee's fingerprint cleared assistant Mamta Patel. The home was toured to conduct a Health and Safety Inspection. Licensee is in ratio today. The facility currently operates Monday through Friday from 8:30am until 6:00pm.

ON LIMITS: Entire first floor (Living, Dining, kitchen and downstairs bathroom), backyard.
OFF LIMITS: Entire second floor and garage. Off limit areas are inaccessible by closed and/or locked doors and visual supervision.

The home is a two story home with an outdoor play area that is fenced. The stairway has child safety gates in place at the bottom of the stairs. There are 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 in the on-limit areas during today's inspection.

The home has a fully charged 3A10BC fire extinguisher (located in garage), working smoke/carbon monoxide detector, and working telephone. The licensee and assistant have current CPR and First Aid certificates completed and expire 10/2023. Mandated Reporter training was completed on 1/29/2022 and 2/15/2022 for both licensee and assistant. The fireplace is screened with a glass door to prevent access by children. Per licensee, there are no firearms or weapons in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 11/14/2022. The licensee and assistant is in compliance with the immunization laws which pertains to all childcare providers.

See LIC809C for continuance..
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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: CHHATRAPATI, KOMAL
FACILITY NUMBER: 013420878
VISIT DATE: 03/27/2023
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LPA Wright requested and reviewed the files of six (6) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee has current day care insurance through Markel Insurance. All required forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. There are No IMS provided at this home. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

California Law requires Child Care Centers 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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Licensee was reminded that all adults 18 and over, 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 childcare center. 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. All forms can be downloaded at www.ccld.ca.gov



There are no deficiencies cited. A notice of site visit was given and must remain posted 30 days. Exit interview conducted and report was review with licensee Komal Chhatrapati .
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
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