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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409179
Report Date: 07/09/2021
Date Signed: 07/09/2021 12:02:19 PM

Document Has Been Signed on 07/09/2021 12:02 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MOKTAN, SHRADAFACILITY NUMBER:
073409179
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/09/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Shrada MoktanTIME COMPLETED:
12:15 PM
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On 7/9/21 at 10:15 am Licensing Program Analysts (LPAs), Monica Mathur and Michelle Sutton conducted an announced Pre-licensing Inspection at Shrada Moktan's home and met with Applicant, Shrada who has applied for a Small Family Child Care Home with a capacity of eight (8). Days and hours of operation will be Monday through Friday from 7:30 AM to 6:00 PM. There are total of two adults residing in the home - Applicant and her spouse. There are two (2) children under the age of 18 years living in the home - ages 2 and 4. Applicant completed the 16-hour Preventive Health & Safety training which includes 8 hour Pediatric CPR and First Aid, one hour of Child Care Nutrition and Lead Poisoning. Applicant has documentation maintained for Measles, Pertussis Immunizations, Influenza for the current flu season. Applicant and other adult living in the home have Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Applicant has Mandated reporter training. Applicant owns the home and a copy of the ownership documents are on file. LPA reminded Applicant that when care for more than six and up to eight is provided, Applicant must notify parents. Applicant was informed to use the Affidavit Regarding Liability Insurance form to inform parents if she does not carry a day care insurance. Applicant has a working telephone in the home.

INDOOR SPACE: At 10:20 am LPA inspected the indoor space of the home. The home is single story, consisting of 4 bedrooms (of which 1 converted into Play Room for day care), 2 bathrooms, kitchen, dining area, living room, attached open port garage. The indoor home is sanitary, safe and orderly, with heating and ventilation for safety and comfort.
IN-USE AREAS: Living room, Kitchen/Dining area, Play room, Bathroom 1
OFF LIMIT AREAS: Open port Garage, Master bedroom (locked), 2 Bedrooms (locked) Master Bathroom. A door from the Master Bathroom leads to the outside open port garage. Another access to the garage is from the outdoor yard, both are locked.

Continued.....
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MOKTAN, SHRADA
FACILITY NUMBER: 073409179
VISIT DATE: 07/09/2021
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There are no stairs in the home. Fireplace in the living room is barricaded by a heavy couch. Closets in the hallway are locked. LPA observed: fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detector in hallway. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets with latches and locks. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. A trampoline is placed in the off limit outdoor area and Licensee understands she cannot use it for day care children during operating hours. Applicant states that there are no pets or arms and ammunition stored in the home.

OUTDOOR SPACE: At 10:45 am LPA toured the outdoor area. There is a swimming pool which is fenced (5 feet high) and has 2 gates that swing outward and are locked, Right side yard around the pool is off limit. Only the left side will be used which has turf grass, swings and play equipment. LPAs observed that the backyard fence is not in good, safe condition. Several large gaps and loose planks were observed that are unsafe for children. Applicant states they will be building a new fence with their neighbor in August and do not plan to start day care before that.

At 11:00 am Discipline policy was discussed, and Applicant stated she will talk to the children and sometimes used time out as form of discipline. Applicant understands that children's personal rights should not be violated and no corporal punishment. Applicant will be serving snacks and meals to children. LPA discussed requirement to label child bottles and food brought from home, and Healthy Beverage Act. Isolation of sick children (in Play room), supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries and requirements for assistant/substitute were also discussed. Fire drills must be practiced once every six months and documented.
LPA discussed Incidental Medical Services (IMS) policy. Applicant does not plan on providing IMS at this time. 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.LPA reminded Applicant of the applicable $100 civil penalty per person per day, a minimum of $100.00 to a maximum of $3000.00 per person for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children.

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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MOKTAN, SHRADA
FACILITY NUMBER: 073409179
VISIT DATE: 07/09/2021
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LPA discussed Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe Sleep regulations and information was discussed and provided.

Website links for provider resources: Sign up for free Quarterly Updates.
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
OR EMAIL TO:
childcareadvocatesprogram@dss.ca.gov

The following items to be completed prior to licensure of a Small Family child care home:
- New installed or repaired backyard fence, ensuring no open gaps that can be potentially dangerous to children in care.
- Required postings

A Family Prelicensing Packet will be provided and reviewed after the second prelicensing inspection; once the backyard fence is completed. Applicant agreed to call CCLD after the above corrections have been completed.

At 11:15 am exit interview was conducted with Applicant who signed the report acknowledging receipts of documents.

End of Report
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC809 (FAS) - (06/04)
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