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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409179
Report Date: 12/20/2023
Date Signed: 12/20/2023 03:14:46 PM

Document Has Been Signed on 12/20/2023 03:14 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:MOKTAN, SHRADAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 702-8903
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
12/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Shrada MoktanTIME COMPLETED:
03:30 PM
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On 12/20/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection and met with Licensee, Shrada Moktan. Licensee wants to make changes in the areas to be used for daycare. Fire clearance was granted on 9/6/22 with no limitations mentioned when facility was approved for large family home in 10/2022.

Starting 1/2/23 the new on-limit and off-limit areas will be:
ON LIMIT AREAS: Access to daycare will be from left side of front driveway adjacent to garage, Play Room, Bathroom near kitchen, Area inside sliding door and kitchen, Entrance area outside Playroom (fake grass area, fenced and gated)
OFF LIMITS AREA: Kitchen, Living Room, Dining nook near living room, 3 Bedrooms, 1 hallway Bathroom, Garage.
Use of outdoor on limit and off limits remains the same. There is a fenced swimming pool (5 feet high) with self latching gates. LPA reminded that 100% visual supervision is required when children are in the backyard near pool area and licensee must ensure pool gates are inspected daily and locked/latched before children go out to the yard. Licensee is reminded to keep all off limit areas in the home inaccessible to children through locked/latched gates and/or doors.

Licensee's parents are newly added adults now residing in the home. They completed Live Scan and are awaiting tuberculosis results. Licensee is maintaining Sleep Logs for all infants, and no loose objects/articles were observed during today's inspection. Today there were 5 children present (2 infants, 3 preschool age) with Licensee and spouse.

Exit interview conducted with Licensee, Shrada Moktan. Notice of Site Visit was issued, must be posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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