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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422736
Report Date: 08/23/2023
Date Signed: 08/23/2023 02:11:12 PM


Document Has Been Signed on 08/23/2023 02:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:LAKSHMANAN, LAKSHMI PRABHAFACILITY NUMBER:
013422736
ADMINISTRATOR:LAKSHMANAN, LAKSHMI PRAHBHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 592-1617
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 4DATE:
08/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lakshmi Prabha LakshmananTIME COMPLETED:
02:15 PM
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On August 23, 2023 at approximately 11:15am 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 adolescent sons (ages 15 and 16). Present for today’s inspection was licensee Lakshmi Prabha Lakshmanan and her fingerprint and TB test cleared husband and helper Xuan Thuy Tram. There were 4 children in care (3 three-years-old; 1 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. There is a friendly German Shepherd 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 on the right side of the hall, away from the other children in care. The licensee owns the property and carries liability insurance through State National Insurance Company, policy expires 11/26/2023.All required licensing documents are posted and visible for public review.


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.
There is a fully charged 2A10BC fire extinguisher, mounted in the dining 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, however, the last a drill was conducted 12/05/2022. Drills must be conducted at least once every six months – see LIC809D for deficiency.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LAKSHMANAN, LAKSHMI PRABHA
FACILITY NUMBER: 013422736
VISIT DATE: 08/23/2023
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 Children's files were reviewed and found to be complete and in good order. The facility roster was reviewed, and a copy taken for the office file. Licensee has not been caring for infant children and only caring for potty trained children over the age of two. However, due to the new Transitional Kindergarten (TK) rules affecting the age of school age children, the licensee is interested in taking infant children.

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.

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 for licensee and helper is current and expires 8/20/2025. Mandated Reporter certificate for licensee and helper expired on 6/29/2023 – see LIC809D for deficiency. LPA reminded the licensee of the following: Mandated Reporter certificate and CPR/First Aid certificate must be 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,

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.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LAKSHMANAN, LAKSHMI PRABHA
FACILITY NUMBER: 013422736
VISIT DATE: 08/23/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, licensee Lakshmi Prabha confirmed there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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 2 deficiencies issued during today’s inspection:

- Disaster drills were not completed at least once every 6 months as required

- Mandated Reported certificates expired June 21, 2023

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.



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 CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/23/2023 02:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: LAKSHMANAN, LAKSHMI PRABHA
FACILITY NUMBER: 013422736

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that last disaster drill was completed on December 2, 2022, more than six months ago which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/24/2023
Plan of Correction
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Licensee to conduct a fire or earthquake disaster drill and going forward, ensure they are being done at least once every six months. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that licensee and helper's mandated reporter certificates expired which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2023
Plan of Correction
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Licensee and helper to go to MandartedReporterCA.com and renew their certificates. Going forward, licensee reminded to renew this certificated every two years.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023
LIC809 (FAS) - (06/04)
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