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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625554
Report Date: 01/22/2024
Date Signed: 01/22/2024 11:14:05 AM

Document Has Been Signed on 01/22/2024 11:14 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KOCHI, MANIZHAFACILITY NUMBER:
343625554
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Manizha KochiTIME COMPLETED:
11:35 AM
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On January 22, 2024 at approximately 10:30 AM, Licensing Program Analysts (LPA) Michelle Perez met with Applicant Manizha Kochi for the purpose of a change of location inspection. Licensee was previously licensed at 343624606. Spouse was present and no children were in the home during the inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday through Friday from 7am to 6pm.

A health and safety inspection was conducted inside and out. This facility is single story home. The home has three bedrooms, two bathrooms, dining area, family room, kitchen, small office, garage and a backyard w/ shed. The off-limit areas: Children's room, garage & shed in backyard.

Off-limits areas will remain inaccessible to children by closed doors and/or supervision. Toxic and hazardous items are inaccessible to children and are stored in the latched kitchen cabinets. Functioning smoke and carbon monoxide detectors and fire extinguisher were observed in the home. LPA received EMSA certified certificate for Preventative Health and Safety training, Applicant's pediatric CPR and First Aid training is valid until 06/2024. Applicant stated that there are no weapons in the home. LPA observed a fireplace in the living room area which is barricaded. Supervision was discussed and applicant understands that children must be 100% supervised in unfenced yards. Immediate Civil Penalty regulation and deficiencies were reviewed. There are no bodies of water on the premises.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KOCHI, MANIZHA
FACILITY NUMBER: 343625554
VISIT DATE: 01/22/2024
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This facility does plan to provide Incidental Medical Services (IMS) if needed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Licensee will provide care for infants and is practicing safe sleep regulations, to include the 15- minute sleep logs.

Effective today January 22, 2024 the facility is licensed for small family child care home.


Facility is approved for a small family childcare home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6. Exit interview conducted.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC809 (FAS) - (06/04)
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