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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422346
Report Date: 07/29/2020
Date Signed: 07/29/2021 10:17:57 PM

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:GURRALA, SARASWATHI & KRISHNAFACILITY NUMBER:
013422346
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
07/29/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Krishna & Saraswathi GurralaTIME COMPLETED:
04:30 PM
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On 07/29/20 at 3:30pm, Licensing Program Analyst (LPA) Briana Plumboy conducted an announced Case Management Inspection via Facetime with Licensees Krishna & Saraswathi Gurrala. Present for the inspection was 5 children in care (2 preschool age children and 3 infants) as well as licensees fingerprint clear and associated mother Samrajyamma Gurrala.. The home was virtually toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:00am until 7:00pm.

ON LIMITS: living room, bathroom, the daycare room in the back room of the home, and a portion of the backyard.

OFF LIMITS: dining room, the kitchen, the garage, the laundry room, and the entire 2nd level

The isolation area will be the living room. There is a 3A40BC fire extinguisher, carbon monoxide detector, pull down fire alarm, and smoke detector which meet State Fire Marshall standards during today's inspection.
Per licensee, there are no firearms in the home. There are no pets in the home. All required licensing documents are posted and visible for public review. Both licensees CPR and First Aid certificate are current and expire 03/07/22. Both licensee received mandated reporter training certificates on 02/01/20. Both licensees have received the required provider immunization's.

See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2020
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GURRALA, SARASWATHI & KRISHNA
FACILITY NUMBER: 013422346
VISIT DATE: 07/29/2020
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On 07/16/20, a fire clearance was granted to facility #013422346 by Union City Fire Department. All documents have been received for the increase of capacity application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .

As of 07/29/20, this home is recommended for an increase of capacity. There are no deficiencies cited today. The report will remain on file for three years. A notice of site visit was provided, and the licensee was reminded to have it posted for 30 days. This entire report has been read to the Licensee by LPA Plumboy. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Plumboy or CCLD. An exit interview was conducted, and appeal rights provided.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2020
LIC809 (FAS) - (06/04)
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