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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409179
Report Date: 08/03/2021
Date Signed: 08/03/2021 10:01:33 AM

Document Has Been Signed on 08/03/2021 10:01 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, 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: 2DATE:
08/03/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Shrada MoktanTIME COMPLETED:
10:00 AM
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ON 8/3/21 at 9:15 AM Licensing Program Analysts (LPAs) Monica Mathur and Michelle Moktan conducted an announced subsequent Prelicensing Inspection at Shrada Moktan's home. LPAs met with Applicant Shrada. Present in the home were Applicant, her spouse and her two children (preschool age).

Purpose of the inspection is to check on the swimming pool requirements in the backyard. LPAs inspected the entire backyard, swimming pool and observed the new fence has been installed. Swimming pool meets all requirements per Title 22 regulations.

Required postings were put up near the front entrance during inspection.

Applicant needs to secure the large play equipment (swings, slide set) to the ground. LPA will conduct a follow up inspection once correction is completed. Subject to play structure being secured, Applicant's home is ready to be licensed for a Small Family Childcare Home.

The Prelicensing forms packet was provided and reviewed with Applicant.

At 9:45 AM exit interview was conducted. LPA reviewed the report, additional corrections with Applicant.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2021
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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