394500986-1-10-2024-53-CC-ETJA-CZCR32-20240110113913

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500986
Report Date: 01/10/2024
Date Signed: 01/10/2024 11:39:23 AM

Document Has Been Signed on 01/10/2024 11:39 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	PATTNAIK, MANOJINI		FACILITY NUMBER:	394500986
ADMINISTRATOR:	PATTNAIK, MANOJINI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 386-7686
CITY:	LATHROP	STATE: CA	ZIP CODE:	95330
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	01/10/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Manojini Pattnaik		TIME COMPLETED:	12:00 PM

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Licensing Program Analyst (LPA) Erwin Tjhia met with licensee, Manojini Pattnaik for the purpose of a prelicensing evaluation. Applicant's tentative hours are Monday - Friday from 8 AM to 6 PM. Licensee is requesting a change of location from old facility with license #073408374 to current location. The facility has received a fire clearance from the Lathrop-Menteca Fire Department clearing the home for a large family home day care on 01/03/2024.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

The facility is a two stories home that consists of 5 bedrooms, and 4 1/12 bathrooms. LPA and Licensee toured the entire home inside and outside. Off limit areas consist of the entire upstairs and garage. Licensee acknowledged that children are never allowed in the off limit areas. Off limit areas will remain inaccessible by door handle covers, locked closed doors and supervision. Licensee understands that 100% supervision is required when children play any unfenced areas outside.

LPA discussed licensing requirements with Licensee including the posting of licensing inspection notices and reports, as well as injury and incident reporting. Fire extinguisher type 3A40BC located at the small room next to the kitchen and first aid kit is located in the cabinet in the living room. Smoke alarm and carbon monoxide detectors were observed to be in operational order. Licensee stated there are no weapons in the home. There are no bodies of water on the property. There no fireplace at the facility.

Report Continue 809-C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PATTNAIK, MANOJINI	FACILITY NUMBER: 394500986
	VISIT DATE: 01/10/2024

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Hazardous items and personal hygiene items are made inaccessible to children. Sharp utensils are stored in locked drawers. Licensee has a current Mandated Reporter Training Certificate that expires 01/05/2025. Current pediatric CPR and first aid training was verified and expires 09/30/2025. LPA discussed new safe sleep regulations. In addition, LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. LPA provided a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, for licensee during today's inspection.

LPA discussed IMS services and the requirement to create a plan of operation. 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.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Licensee understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Licensee understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction.

Report Continue on 809-C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PATTNAIK, MANOJINI	FACILITY NUMBER: 394500986
	VISIT DATE: 01/10/2024

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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.

Exit interview conducted and report was reviewed with the licensee. Records, postings and reporting requirements were discussed. Licensee was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

As of today, Licensee will be approved for a Large Family Child Care Home to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC809 (FAS) - (06/04)

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