073408374-6-26-2023-52-CC-MPRE-CT6NWT-20230626105004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408374
Report Date: 06/26/2023
Date Signed: 06/26/2023 10:50:14 AM

Document Has Been Signed on 06/26/2023 10:50 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:	PATTNAIK, MANOJINI		FACILITY NUMBER:	073408374
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 4	CENSUS: 1	DATE:	06/26/2023
TYPE OF VISIT:	Required - 1 Year	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Manojini Pattnaik		TIME COMPLETED:	10:46 AM

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	On 6/26/2023 at 9:00am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Manojini Pattnaik for a Required – 1 Year Inspection and an Increase of Capacity Inspection. Present during the inspection was the Licensee and one (1) preschool age child who arrived at 10:13am. Licensee’s husband and son were upstairs in a off limit area during the inspection. Licensee lives in the home with her husband and their ten (10) year old son. The facility operates from 8:30am – 5:30pm, Monday - Friday. ON LIMITS AREA: Entire 1^st Floor: Living Room, Dining Area, Kitchen, Family Room, Downstairs Bathroom and Backyard OFF LIMITS AREA: Entire 2^nd Floor and Garage ISOLATION AREA: Family Room This home was granted a fire clearance from the San Ramon Valley Fire Protection Department on 6/15/2023 with the condition that the second floor remains off limits and the gate on the stairs remains in place during operational hours. The facility is a two-story home owned by the Licensee. The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, personal medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms and no pets in the home. LPA did not observe any harmful bodies of water in or around the home.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PATTNAIK, MANOJINI	FACILITY NUMBER: 073408374
	VISIT DATE: 06/26/2023

NARRATIVE

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Licensee is operating within their licensed capacity and is in ratio. The home has one (1) fully charged 2A10BC fire extinguisher hanging on the wall in between the kitchen and the family room. One (1) working detector is in the entry way above the downstairs bathroom and one (1) working carbon monoxide detector is in the family room. The home is equipped with central heat and air for proper ventilation. All napping equipment is clean, free from defects and properly maintained. Licensee provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. The fireplace in the living room is blocked with furniture and not in use making it inaccessible to the children in care. There is a China cabinet in the living room that is blocked by furniture and there is a small fish tank in the family room. The staircase is gated making the second floor and the staircase inaccessible to the children in care. Licensee stated that she does not transport children. LPA inspected the backyard which is fully fenced with ample age-appropriate materials for the children.

Licensee’s Health and Safety training has been completed and Pediatric CPR and First Aid training is completed and expires 8/7/2023. Licensee’s Mandated Reporter training is complete and expires 1/5/2025. All required forms are posted and visible for public view in the living room. Fire drill log is complete with the last drill logged 6/8/2023. All adults living and working in the home have obtained a criminal record clearance. LPA obtained the children’s files, facility files, and facility roster. All files were complete. No deficiencies were cited during this inspection.

Licensee was reminded that California Law requires 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 624B). Incidents must be reported within 24 hours by phone, fax, or email. Licensee was reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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: PATTNAIK, MANOJINI	FACILITY NUMBER: 073408374
	VISIT DATE: 06/26/2023

NARRATIVE

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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/.

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.

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, the LICENSEE Manojini Pattnaik, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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: PATTNAIK, MANOJINI	FACILITY NUMBER: 073408374
	VISIT DATE: 06/26/2023

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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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee is approved for a increase in capacity.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the license Manojini Pattnaik.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC809 (FAS) - (06/04)

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