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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422793
Report Date: 05/31/2019
Date Signed: 05/31/2019 03:59:46 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:KRISHNAKUMAAR, JANANIFACILITY NUMBER:
013422793
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/31/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Janani KrishnakumaarTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Simerjit Kaur met with licensee Janani Krishnakumaar for an UNANNOUNCED ANNUAL RANDOM INSPECTION. The home was toured for Health and Safety Inspection. Present for this inspection are licensee's fingerprint cleared and associated father Thanumamoo Muthiahreddiar, father-in-law Ravichandr Thirupapuliyur, mother-in-law Bhanumathi Ravichandran, and 3 preschool age children in care.

The home is double story. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are first level: the family room, kitchen, half bathroom and bedroom. The OFF LIMIT AREAS are second level: master bedroom/bathroom, 3 bedrooms, 1 bathroom, living room, backyard and garage, which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the family room. The BACKYARD play area is not securely fenced. Licensee uses park and middle school grounds for outside play time. There are toys. It was observed that there are no toxins or hazardous items accessible during the inspection. During the inspection, it was also observed there are no pools, hot tubs or any bodies of water on premises.

The home has a fully charged with 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR and First Aid certificate is current and expires 10/21/20. Licensee is in compliance with the immunization law which pertains to day care providers. Licensee and her assistants are incompliance with Mandated Reporter Training course. Per licensee, there are no firearms in the home. The last conducted fire and disaster drill was documented on 03/22/19. Required licensing documents are posted. Per licensee, there are no children on any type of prescription medications today. Incidental Medical Services were discussed. Licensee will submit an updated plan of operation if in the future she provides any IMS services to a child in care.
See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 292-7241
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: KRISHNAKUMAAR, JANANI
FACILITY NUMBER: 013422793
VISIT DATE: 05/31/2019
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LPA reviewed (2) Children files, facility roster reviewed and copy obtained. The licensee is in ratio today. Safe sleep regulation information was discussed. LPA discussed information for change of capacity.

California Law requires Family Child Care Home licensees to Report Unusual incidents or injuries to children in care to the child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Do not leave an Unusual Incident Report on the Licensing Program Analyst voice mail.

LPA informed licensee of Assembly Bill 1207, the mandated reporter training which can be found at www.mandatedreporterca.com.



For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

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.

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

No deficiency cited today. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 292-7241
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2