013422736-8-29-2022-52-CC-RHAR-CHRP6B-20220829110203

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422736
Report Date: 08/29/2022
Date Signed: 08/29/2022 11:02:21 AM

Document Has Been Signed on 08/29/2022 11:02 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	LAKSHMANAN, LAKSHMI PRABHA		FACILITY NUMBER:	013422736
ADMINISTRATOR:	LAKSHMANAN, LAKSHMI PRAHBH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 592-1617
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	14	CENSUS: 9	DATE:	08/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Lakshmi Prabha		TIME COMPLETED:	11:10 AM

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	On August 29, 2022 at approximately 8:40am Licensing Program Analyst (LPA) Russ Haderer arrived for an unannounced visit to conduct an annual inspection for health and safety. Living in the home is the licensee, her TB test and fingerprint cleared husband and their 2 sons (14 and 16). Present for today’s inspection was licensee Lakshmi and her fingerprint and TB test cleared husband. There were no children in care upon arrival. During the visit, 9 children arrived (3 two-years-old; 3 three years-old; 3 four years-old). The hours of operation will remain Monday-Friday, 9:00am to 6:00pm. The facility is a single-story home with 4 bedrooms, 2 bathrooms a kitchen; dining room, living room, attached 2-car garage, front, side and back yards (hot tub has been removed). There is a German Shepard family pet with a license and up to date vaccinations. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Per the licensee, the ISOLATION AREA will be in the on-limits bedroom down the hall, away from the other children in care. On-limit-areas include: The living room, bedroom on the right side of the living room (day care area), kitchen, dining room, main house bathroom and bedroom next to main house bathroom. The patio in the back yard surrounded by child fencing. Off-limit-areas include: The master bedroom and attached bathroom at the end of the hall, the second bedroom on the left side of the hall near the front of the house, the attached 2-car garage the side yard of the house (contains a locked shed and side yard on the east side of the home. All off limit areas are inaccessible by closed and/or locked doors, child gates and visual supervision. Children's files were reviewed and found to be complete and in good order. The facility roster was reviewed, and a copy obtained.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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: LAKSHMANAN, LAKSHMI PRABHA	FACILITY NUMBER: 013422736
	VISIT DATE: 08/29/2022

NARRATIVE

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There is a fully charged 2A10BC fire extinguisher, mounted in the ding room, a working (tested) carbon monoxide and smoke detectors. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 7/14/2022. All required licensing documents are posted and visible for public view.

The outdoor play area in the back yard is very large with a tennis court and child fencing to keep the children out of the side yard that has a locked shed. There were ample age appropriate toys that were observed to be safe and in good condition. In the day care room there is a free standing fireplace with a child gate surrounding it. The day care rooms are neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials, or toxins accessible to children on the premises during the inspection.

The licensee’s Pediatric CPR/First Aid certificate is current and expires 8/21/2023. Mandated reporter training was completed on 6/29/2021. LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. Licensee, her assistant and all adults living in the home are in compliance with immunization law which pertains to day care providers,

The licensee owns the property and carries liability insurance through State National Insurance Company, policy expires 11/26/2022.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. 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

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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: LAKSHMANAN, LAKSHMI PRABHA	FACILITY NUMBER: 013422736
	VISIT DATE: 08/29/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There were no deficiencies issued during today’s inspection: This report will remain on file for 3 years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Lakshmi Prabha Lakshmanan .

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC809 (FAS) - (06/04)

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