015700268-9-22-2021-52-CC-JWIS-C74PNU-20210922112831

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700268
Report Date: 09/22/2021
Date Signed: 09/22/2021 11:28:36 AM

Document Has Been Signed on 09/22/2021 11:28 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GHOSH, REZY		FACILITY NUMBER:	015700268
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/22/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Rezy Ghosh		TIME COMPLETED:	11:48 AM

NARRATIVE

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On 09/22/2021 at 8:50am Licensing Program Analyst (LPA) Jonathan Williams met with Applicant, Rezy Ghosh, for the purposes of conducting an announced prelicensing inspection. Present during today's inspection are the Applicant and the Applicant's fingerprint cleared and associated spouse. All adults in the home are fingerprint cleared and associated. The home was toured to conduct a health and safety inspection.

On-limit-areas: Living/dining room, first floor bedroom, first floor bathrooms (including "powder room".
Off-limit-areas: Garage, backyard, kitchen, entire second floor,.
Isolation area: Living/dining room near the couch.

The interior of the home was toured at 8:50am. The facility is a two-story home owned by the Applicant, and Applicant produced proof of control of property. The first floor consists of two bathrooms, a bedroom, kitchen, living/dining room, backyard, and garage. The second floor consists of three bedrooms, two bathrooms, loft, laundry room, and three storage areas. The home is neat and clean. All toxins, medications, hazardous materials, and cleaning compounds were observed by LPA to be made inaccessible to children. Per Applicant statement, there are no firearms kept in the home. There is an electric fireplace kept in the home and LPA observed it to be barricaded to prevent access by children. There is a dog kept in the home, and Applicant stated that the dog will be kept in an off-limit area of the home while children are present.

A 2A10BC fire extinguisher was observed at 10:10am to be located near the entryway into the garage. A fully stocked first aid kit was observed to be present in the home at 10:55am. Applicant tested carbon monoxide and smoke detectors and LPA observed them to be functional at 10:43am.

Applicant has required Preventive Health and Safety Training certificate. Applicant has current CPR/1st Aid certificate which expires on 2/8/2022. Mandated Reporter training certificates for Applicant are current, and expire on 8/25/2023.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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: GHOSH, REZY	FACILITY NUMBER: 015700268
	VISIT DATE: 09/22/2021

NARRATIVE

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Applicant was reminded that all adults 18 and over living or working in the home, 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.

Applicant was reminded that California Law requires licensed Family Child Care Homes 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. LPA informed the Applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the Applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Applicant was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Incidental Medical Services (IMS) policy was discussed at 11:08am. Applicant was reminded that when any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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.

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.

The Applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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: GHOSH, REZY	FACILITY NUMBER: 015700268
	VISIT DATE: 09/22/2021

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided to the Licensee and the signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee. This home is recommended for a license for a small Family Child Care Home effective 9/22/2021.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC809 (FAS) - (06/04)

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