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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701094
Report Date: 04/17/2024
Date Signed: 04/17/2024 11:37:31 AM

Document Has Been Signed on 04/17/2024 11:37 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:THIGETI SANGMA, SABINAFACILITY NUMBER:
015701094
ADMINISTRATOR/
DIRECTOR:		SABINA THIGETI SANGMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 256-1337
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/17/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Applicant, Sabina Thigeti SangmaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jyoti Saini conducted a scheduled pre-licensing inspection today, arriving at 9:05 am and met with Applicant Sabina Thigeti Sangma. The applicant initially applied for a large family child care home (FCCH); however, the request was later withdrawn. Upon returning to the office, the LPA will update the system to reflect the change. LPA and Applicant inspected the entire house for Health and Safety Hazards. The Applicant owns this property. A copy of the property tax was reviewed and shows control of the property. The Applicant resides in the house with her husband. The single-story home consists of three bedrooms, two bathrooms, a living room, a kitchen, a dining area, a garage, and a backyard. The Applicant plans to operate from 8:00 am to 5:00 pm Monday through Friday.
On-limit areas: bedroom #1 by the entrance ( nap room ), living room, dining area, bathroom #1, and half backyard.
Off- limit areas: kitchen, master bedroom, adjacent bathroom, bedroom #2, garage, and half backyard.
The home appears neat and clean, with heating and ventilation for safety and comfort. The ISOLATION AREA will be the nap room. All off-limit areas are properly barricaded. During the inspection, no pools, hot tubs, or other bodies of water were on the premises. All hazardous materials and toxins are kept out of the reach of children. The Applicant has required a Preventive Health and Safety Training certificate, including a lead poisoning prevention update. The Facility will provide snacks and meals. The applicant's First Aid/CPR certificate expires on 02/2026. The Mandated Reporter training certificates for the Applicant are current and expire on 1/30/2026. The Applicant is reminded that NO walkers, exersaucers, jumpers, bouncers, or any similar items are to be used for children in care and shall be made inaccessible. The Applicant is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. The applicant states that the discipline policy is redirection. Per Applicant, she may or may not purchase liability insurance; she was advised to use the Affidavit form regarding liability insurance for FCCH. Licensee was advised to post the License when she received it.
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SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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: THIGETI SANGMA, SABINA
FACILITY NUMBER: 015701094
VISIT DATE: 04/17/2024
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Smoking is prohibited in family childcare homes. The Applicant was also advised to conduct fire/disaster drills once every six months and to log the date and time of the drill. LPA discussed safe sleep guidelines and 15-minute check requirements.
The Applicant 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, 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.

APPLICANT OWNS THE HOME:
The applicant provided proof of control of property.

APPLICANT KNOWS PROSPECTIVE CLIENTS WILL NEED IMS:
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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

Safe Sleep -Family Child Care Homes
LPA discussed the safe sleep regulations with applicant 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 [applicant, licensee, or facility representative] 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.
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SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: THIGETI SANGMA, SABINA
FACILITY NUMBER: 015701094
VISIT DATE: 04/17/2024
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Review of records to be maintained - Family Childcare Homes
LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Applicant was informed of the MyChildCarePlan.org site, 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.


Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Prior to being licensure:

  • updated fire extinguisher
  • install carbon monoxide
  • post required postings.

Exit interview conducted and report was reviewed with the applicant, Thigeti Sangma, Sabina.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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