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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420878
Report Date: 07/10/2024
Date Signed: 07/10/2024 07:22:50 PM

Document Has Been Signed on 07/10/2024 07:22 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CHHATRAPATI, KOMALFACILITY NUMBER:
013420878
ADMINISTRATOR/
DIRECTOR:		CHHATRAPATI, KOMALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 314-5945
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Komal ChhatrapatiTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On July 10th, 2024 at approximately 2:25pm, Licensing Program Analyst (LPA) April Wright met with licensee Komal Chhatrapati for an Unannounced Annual/Random Inspection. Present for this visit were nine (9) children, (4 infants / 5 preschool age) and fingerprint cleared assistant Mamta Patel. The home was toured to conduct a Health and Safety Inspection. Licensee is in ratio today. Hours are Monday through Friday from 9:00am until 6:00pm.

The two story home consists of three (3) bedrooms including master bedroom, two and one half (2 1/2) bathrooms which includes master bathroom, living room, dining/family area, kitchen, backyard and garage. Backyard is completely fenced and free of damage and hazardous conditions. A child safety gate in place at the bottom of the staircase to prevent access to the second level of the home. There are age appropriate toys and furniture that appear to be safe and in good condition as observed by the LPA. The fireplace has a glass door and is locked which makes it inaccessible to children in care. LPA observed and Licensee confirmed there are no pools, hot tubs, or any other bodies of water present in the home.

ON LIMITS: First level of the home - Living room (day-care room #1), Dining/family area (Day-care area #2), and downstairs bathroom (to right of kitchen) and backyard. The isolation area for sick children is in the living room on the couch which is away from children in care.
OFF LIMITS: Second level of the home - All three (3) bedrooms, two bathrooms, kitchen and garage. Off limit areas are made inaccessible by closed and/or locked doors and visual supervision. Child safety gates are in place to prevent access to these areas of the home.
The home has a fully charged 3A40BC fire extinguisher (located in the garage), working smoke/carbon monoxide detectors, and working telephone. LPA observed and Licensee confirmed that are no toxins, medicines, cleaning products or hazardous materials visible during the inspection and were made inaccessible to children in care. Child safety locks are installed on all cabinets and drawers to prevent access. Licensee confirmed that there are no pets, weapons or firearms present at the home.
See LIC809C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: 07/10/2024
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All individuals subject to criminal record review have a clearance or exemption and have been associated to the this FCCH. LPA requested and reviewed the files of nine (9) children in care. The children's files contained all required forms including Parents rights, medical consent forms and identification/emergency contact forms. The children's roster was reviewed and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 4/11/2024. The licensee and assistant have current Mandated reporter training which was completed on 3/16 and 3/21/2024. Licensee and assistant CPR/First aid certificate which expires on 3/2/2026 was completed online and is not EMSA certified. Licensee will contact there resource and referral agency to schedule an appointment to retake the required training. Licensee and assistant immunization records were not present in the personnel file. All required forms are posted and visible for public review upon entry to the home.

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: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 07/10/2024
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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.

During the exit interview, Licensee Komal confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The following Technical Violations were issued during this inspection:

- Technical Violation: Licensee and assistant do not have proof of immunization's in their personnel files.

- Licensee and assistants completed online CPR course which is not EMSA certified nor valid. Licensee will retake the training in person through by contacting R&R for assistance.


A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Komal Chhatrapati.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5