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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500058
Report Date: 05/19/2021
Date Signed: 05/25/2021 08:34:49 AM

Document Has Been Signed on 05/25/2021 08:34 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:DAVE, RUCHIRAFACILITY NUMBER:
394500058
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
05/19/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ruchira DaveTIME COMPLETED:
05:00 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
*NOTE: Due to Covid-19 State of Emergency and DPH guidelines on social distancing, a facetime meeting was conducted. In lieu of Licensee’s signature, the report is emailed with a read receipt request.*
On 19th May 2021 at 2:00pm, Licensing Program Analyst (LPA) Aruna Sridharan met with Ruchira Dave for the purpose of conducting case management visit for an increase of capacity. All adults residing in the home have a criminal record clearance. The hours of operation are Monday through Friday 6:00am to 6:00pm.
LPA Sridharan received the approved fire clearance for the increase of capacity on 05/10/2021. LPA toured the home and observed all areas of the home accessible to children. Off-limit areas include bedroom next to bathroom, laundry room, pantry and garage. Licensee acknowledged that children may never enter these off-limit areas. Licensee stated there are no weapons in the home and LPA did not observe any bodies of water and no fireplace. The front yard is unfenced and the backyard area is fenced.
The licensee understands that 100% supervision is needed when children are in an unfenced area. Licensee shall notify Licensing Agency per regulation 102416.3 prior to making altercations or additions to the home or grounds.
Carbon monoxide, smoke detector and fire extinguisher meet regulations. The fire extinguisher is under the kitchen sink and first aid kit is in hall closet. Hazardous cleaning compounds are stored in the laundry room and under the sink in kitchen and bathroom. Knives are located in the upper cabinet in the kitchen inaccessible to children. The home contains appropriate toys for the children. LPA reviewed postings. LPA obtained proof of enrollment for CPR/First Aid that expired 5/18/2021. The licensee has completed Mandated Reporter certification AB1207 that expires 04/23.
Licensee is following COVID guidelines and precautions to provide care for children at this time. LPA advised the licensee of their responsibility to stay current in the requirements of the Department.
Licensee is approved for a provisional license pending receipt of the First Aid/CPR card. On receipt of the documents by the licensing agency, a regular license will be issued. Provisional license will expire July 1, 2021. A provisional license cannot be extended.
A provisional license is issued on today's date May 19, 2021, for a capacity of 14 with the following capacity; 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2. Licensee understands when not using an assistant the capacity reverts back to the small family day care home license capacity.
No Title 22 deficiencies cited during today's visit. Notice of Site Visit Posted.
SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Aruna Sridharan
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2021
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 1