075700268-7-19-2024-52-CC-MPRE-D7BV26-20240719160238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 075700268
Report Date: 07/19/2024
Date Signed: 07/19/2024 04:02:46 PM

Document Has Been Signed on 07/19/2024 04:02 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CHHIKARA, PALAK		FACILITY NUMBER:	075700268
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/19/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Palak Chhikara		TIME VISIT/ INSPECTION COMPLETED:	03:59 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 7/19/2024 at 2:00pm Licensing Program Analyst (LPA) Morgan Pringle and met with Applicant Palak Chhikara for an Announced Pre-Licensing Inspection. Present during the inspection was the Applicant and her husband. Applicant lives in the home with her husband, and their two (2) minor children. Applicant’s home was toured for a health and safety inspection. The facility plans to operate 8:30am – 5:30pm, Monday - Friday. ON LIMITS AREA: Living Room (used as play area), Family Room, Dining Area, Bedroom across from Hallway Bathroom and Backyard OFF LIMITS AREA: Kitchen, Remaining Two (2) Bedrooms, Two (2) remaining Bathrooms, Laundry Area, and Garage ISOLATION AREA: Family Room The facility is a single-story home rented by the Applicant. The home consists of three (3) bedrooms, three (3) bathrooms, family room, living room, kitchen, dining area, laundry area, and backyard. The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, and hazardous materials have been made inaccessible to the children. All off limit areas in the home have been made inaccessible with closed doors, locks, and gates. The home has centralized heat and air for proper ventilation. Applicant stated that all children’s bedding will be brought from the child’s home, and applicant will provide sleeping mats/cots for the children. Applicant stated she will be providing all meals and snacks for the children. Applicant will also not be providing transportation. There is a 2A10BC fire extinguisher under the kitchen sink. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

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 4

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: CHHIKARA, PALAK	FACILITY NUMBER: 075700268
	VISIT DATE: 07/19/2024

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

There is one (1) working smoke detector in the family room, the hallway, and the off-limit bedrooms. There is one (1) working carbon monoxide detector in the family room. The fireplace in the living room is blocked, making it inaccessible to the children. The backyard is fully fenced with ample space for the children to play. There is a deck with a large canopy for extra shade. Applicant stated there are no firearms and no pets in the home.

The Applicants Health and Safety training has been completed and Pediatric CPR and First Aid certificate is current and expires 2/15/2026. Applicants Mandated Reporter training is complete and expires on 6/11/2026. All adults living in the home have obtained a criminal record clearance. Applicant has provided immunizations for influenza, measles, pertussis and has a current record of tuberculous.

Applicant was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days from the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. Applicant was reminded that any structural changes or additions to the home must be reported to CCLD as well. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. Applicant was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Applicant was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Applicant that all forms can be downloaded at www.ccld.ca.gov.

LPA reviewed with Applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Page 2 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: CHHIKARA, PALAK	FACILITY NUMBER: 075700268
	VISIT DATE: 07/19/2024

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

Applicant 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, 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.

LPA discussed the safe sleep regulations with applicant 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 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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

On this date, 5/17/2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Page 3 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: CHHIKARA, PALAK	FACILITY NUMBER: 075700268
	VISIT DATE: 07/19/2024

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 Applicant provided proof of control of property. Because the Applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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) or (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 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.

LPA has verified that all requirements have been met during this inspection and a license for a small family child care home is approved today, 7/19/2024.

Exit interview conducted and report was reviewed with the applicant, Palak Chhikara.

Page 4 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4