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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421015
Report Date: 07/12/2021
Date Signed: 07/12/2021 11:40:30 AM

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:HOSAHALLI, VINUTHAFACILITY NUMBER:
013421015
ADMINISTRATOR:HOSAHALLI, VINUTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 793-6971
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 12DATE:
07/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Vinutha HosahalliTIME COMPLETED:
11:45 AM
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On July 12, 2021 at approximately 11:05am , Licensing Program Analyst (LPA) Haderer arrived for an unannounced case management visit to review an amendment to the on-limits area of the home. LPA met with licensee Vinutha Hosahalli. Present today was the licensee, her fingerprint cleared and TB tested assistant Baljeet Kaur and licensee's fingerprint cleared and TB tested husband Sathish Chandra Dogganahalli, their 10 year old son and 12 children (toddlers) in care ages 2 to 3 years old. The home was in ratio today.

The new on-limits bathroom is the home's second bathroom connected to the master bedroom.. The bedroom will remain off limits to children other than to pass through to get to the bathroom as guided by an adult and will be used by the toddlers. LPA inspected the bathroom and found no hazardous items or cleaning products accessible to children. Licensee was reminded that other than wipes or things used for the children, the bathroom should be empty of most all items (or locked up) cleaning products and anything hazardous to children.

No other changes to the on-limits or off-limits areas are made today. With the addition of the master bathroom, the home remains as originally licensed.

Exit interview was conducted with licensee, a notice of site visit was provided, and the licensee was reminded to have it posted for 30 days.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
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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