<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409274
Report Date: 07/08/2022
Date Signed: 07/08/2022 03:18:47 PM

Document Has Been Signed on 07/08/2022 03:18 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:CHAUHAN, SHABANA PARVEENFACILITY NUMBER:
073409274
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Shabana Parveen ChauhanTIME COMPLETED:
03:15 PM
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 7/8/22 at 10:50am, Licensing Program Manager (LPM) Loretta Dyson arrived at the home for an announced prelicensing inspection. LPM met with the applicant, Shabana Parveen Chauhan, who submitted an application for a small family child care home license. The applicant's adult child and minor child were also present. There were no children in care. This family child care home will operate Monday-Friday 7:30am-6pm. LPM verified the applicant's phone number and the applicant provided an email.

LPM toured the home with the applicant, to conduct a health and safety inspection. The home is a two story home, which consists of the living room, dining area, kitchen, 3 bedrooms, a loft area, 3 bathrooms, laundry room, garage and backyard. LPM observed that it is neat and clean with heating and ventilation for the safety and comfort of children. The on limit areas include the living room, dining area, downstairs bathroom, loft area, upstairs hallway bathroom, and master bedroom. The kitchen, two bedrooms on the right side at the top of the stairs, master bathroom, laundry room, garage and backyard are off limits and made inaccessible by gates, closed and/or locked doors and visual supervision. The master bedroom will be used for isolation of sick children. The backyard is under construction and off limits to children for now, so the applicant advised that the local park will be used for outdoor play. The applicant was advised that once construction is done and she wants to use the backyard for children, she will need to contact Licensing and have it inspected before using. The applicant was advised that any other area that will be changed to an on limit area will need to be inspected by Licensing prior to use. LPM observed an ample supply of age appropriate toys, equipment and activities available for children, and observed that they are in good condition. LPM did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children. The applicant was advised that all poisons and/or hazardous items must be kept in a locked cabinet/drawer or placed out of reach of children. The applicant stated there are no firearms on the premises. There are birds in a bird cage in the home.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: CHAUHAN, SHABANA PARVEEN
FACILITY NUMBER: 073409274
VISIT DATE: 07/08/2022
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
26
27
28
29
30
31
32
The home is equipped with a fully charged 2A10BC fire extinguisher, working combination smoke/carbon monoxide detector (located at the top of the stairs), working telephone, and first aid supplies. The applicant completed the preventative health and safety training which includes 1 hour of nutrition, but not the new requirement for the lead poisoning prevention training. The applicant completed the online portion of the CPR and First Aid training and was issued a certificate that expires on 1/20/24. The licensee has completed the mandated reporter training. LPM reviewed all of the forms required for the children's files, facility file, posting and other information related to Licensing and the care of children, and left copies with the applicant. LPM advised that applicant of where to obtain additional copies of the forms. LPM observed a board near the front entrance, which the applicant advised will be for the documents that are required to be posted. LPM advised the applicant that the board must always be in a place that is visible to the public.

LPM reviewed children's personal rights and the applicant advised that she understands that children's personal rights should not be violated and no corporal punishment. LPM discussed supervision of children, capacity/ratio options, transportation of children, and requirements for an assistant/substitute. LPM reminded the applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. LPM reviewed fire/earthquake drill information, and how to complete the drill log. LPM demonstrated how to fill out the immunization record for children's files, discussed the applicant's responsibility to ensure the records are up to date and have discussions with parents/guardians if they are not, and advised that it does not need to be done if children are enrolled in school. LPM reminded the applicant to review and follow current COVID-19 guidelines, and to report any injuries requiring medical attention or unusual incidents, including COVID-19 exposures and positive results at the facility. LPM provided the main office number for the Oakland Regional Child Care office for the applicant to call and report injuries or unusual incidents, and reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The applicant was encouraged to periodically review regulations, guidelines and PINS on the website www.ccld.ca.gov.

Licensee 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPM verified that the applicant, and all other adults living in the home, have a criminal record clearance and are associated to the license. Licensee was reminded of the responsibility as a mandated reporter. The licensee was reminded that the mandated reporter training needs to be renewed every 2 years, at www.mandatedreporterca.com.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CHAUHAN, SHABANA PARVEEN
FACILITY NUMBER: 073409274
VISIT DATE: 07/08/2022
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
26
27
28
29
30
31
32
LPM discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPM also informed applicant 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.

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: http://www.ada.gov/childqanda.htm



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 platform.

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.

LPM spoke with the applicant about the resource and referral agency and provided contact information for them.

This facility is recommended for a provisional license effective 7/8/22. The provisional license will be in place until the licensee provides proof of completion of the in-person skills session for CPR/First Aid certification, and proof of completion of the preventative health and safety training that includes the lead poisoning prevention training requirement.

An exit interview was conducted and report was reviewed with the Applicant.

SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3