<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422828
Report Date: 11/25/2020
Date Signed: 11/25/2020 03:16:56 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:PULUSU, VISALAKSHMIFACILITY NUMBER:
013422828
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
11/25/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Visalakshmi PulusuTIME COMPLETED:
03:15 PM
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
DUE TO THE COVID-19 SHELTER IN PLACE ORDER BY THE GOVERNOR OF CALIFORNIA, THIS VISIT WAS DONE VIA TELE-VISIT THROUGH FACETIME.

On November 25, 2020 at approximately 11:00am Licensing Program Analyst (LPA) Russ Haderer met with licensee Visalakshmi Pulusu (VIA TELE-VISIT FACETIME CALL) for the purpose of conducting an announced visit for a Case Management – Other for increase of capacity from a small to a large childcare home. Present today was licensee and fingerprint cleared husband Venkateswara Pulusu, their 12 year old daughter and 5 children in care (one of them arrived during the visit). The ages of the children in care were: 2 at 2yrs, 2 at 3 yrs; 1 at 4 yrs). The hours of operation remain as Monday-Friday, 8:30am to 6:00pm.



The original change in capacity request was delayed due to some construction work being done on the back of the home. The owner added on to the back of the house, increasing the home size by adding an additional large master bedroom with a full bath. A brand-new free-standing two-bedroom mother-in-law apartment was also built in the backyard of the property. Both new areas are fully off-limits. While conducting the inspection, licensee asked to amend a previously off-limits bedroom and reclassify it as on-limits. LPA fully inspected the room and granted the change.

The facility is a single-story home owned by the licensee consisting of a living room, kitchen, house bathroom in hallway, four bedrooms, two of which have their own full bathrooms (total 3 full bathrooms in the home) and a single car garage. The living room has a fireplace, but it is not in use and has been blocked off with a large heavy piece of furniture made of solid wood. As previously mentioned, the property also has a free-standing 2-bedroom mother-in-law apartment in the backyard. The home has an enclosed front yard and fully fenced backyard. CONTINUED PAGE 2.........................

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

DATE: 11/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020
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 3
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: PULUSU, VISALAKSHMI
FACILITY NUMBER: 013422828
VISIT DATE: 11/25/2020
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
26
27
28
29
30
31
32
The home is neat and clean with heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the back right on-limits bedroom away from other children in care.

On-limit-areas include: Living room, kitchen, main house bathroom in the hallway, two bedrooms, and backyard covered deck. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. All cabinet doors in the kitchen and house bathroom had childproof locks on them.

Off-limit-areas include: Two master bedrooms and attached bathrooms (doors have locks to prevent child access), single car garage and free-standing two-bedroom mother-in-law apartment in the back yard. The off-limit area will be inaccessible by closed and/or locked doors. There are no hazardous cleaning chemicals or other liquids accessible to children.



The facility was granted a fire clearance on 10/27/2020 from the Fremont City Fire Department. The fire clearance states that daycare in garage not permitted in the single-story home. The home is equipped with a fully charged 3A40BC fire extinguisher, a working and tested smoke and a carbon monoxide detectors. Per the Licensee there are no firearms in the home.

LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection.

There is age appropriate equipment that appears to be safe and in good condition. Licensee’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires 12/07/2021. Licensee completed and received a certificate in mandated reporter training (verified AB1207), expires on 02/23/2021. Licensee is in compliance with the immunization laws which pertains to day care providers. Licensee and husband have completed a TB test.

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. LPA discussed Unusual Incidents Reports. Ratios were discussed and a copy left for licensee as a reminder. CONTINUED ON PAGE 3............................................

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

DATE: 11/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: PULUSU, VISALAKSHMI
FACILITY NUMBER: 013422828
VISIT DATE: 11/25/2020
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
26
27
28
29
30
31
32
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. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

LPA Haderer provided a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes.

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

The facility is approved for the capacity change effective November 25, 2020. A new license will be printed and a record of this will remain on file. Licensee was reminded there needs to be a fingerprint cleared assistant working in a large facility and if the licensee is the only person present, the facility must be operated as a small facility with a maximum of 8 children.

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

DATE: 11/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3