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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422828
Report Date: 04/20/2022
Date Signed: 04/20/2022 04:25:37 PM


Document Has Been Signed on 04/20/2022 04:25 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:PULUSU, VISALAKSHMIFACILITY NUMBER:
013422828
ADMINISTRATOR:PULUSU, VISALAKSHMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 378-3866
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 10DATE:
04/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Visalakshmi PulusuTIME COMPLETED:
04:40 PM
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On April 20, 2022 at approximately 1:15pm Licensing Program Analyst (LPA) Haderer arrived and met with the licensee Visalakshmi Pulusu for the purpose of conducting an unannounced 1-year annual inspection for Health & Safety. Present in the home today was the licensee, her fingerprint and TB tested husband, their adolescent daughter, two assistants and 9 children in care (2 infants; 3 two-years old; 2 three-years old; 2 four-years old), the facility is in ratio today. Hours of operation are Monday-Friday 8:30 to 6:00pm.

The facility is a single-story home with 4 bedrooms; 3 bathrooms; living room; kitchen; eat-in dining room in the kitchen; attached 1-car garage; front, back and side yards. There is a free-standing 2-bedroom 2-bathroom mother-in-law apartment in the back yard of the property. There is a screened fireplace in the living room blocked by a large piece of furniture. The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the emergency on-limits bedroom away from the other children in care. All required postings are present.

ON LIMIT AREAS: Living room; kitchen; eat-in dining room in the kitchen, bedroom on the left side of the house bathroom; bedroom (emergency bedroom) on right side of the house bedroom; the house bathroom on the left side of the hall; backyard covered concrete patio area. 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 cabinets in the kitchen and house bathroom had childproof locks to prevent access by children.



OFF LIMIT AREAS: Bedroom on the right side of the hall (including attached bathroom); master bedroom and bath at the end of the hall in the rear of the home; attached 1-car garage; and western side of the backyard with a free-standing 2-bedroom mother-in-law apartment unit and the artificial grass area in from of the unit. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
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: PULUSU, VISALAKSHMI
FACILITY NUMBER: 013422828
VISIT DATE: 04/20/2022
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The home has a fully charged 3A40BC fire extinguisher mounted in the kitchen by the front door, combined smoke and carbon monoxide detectors (tested and working) and a working telephone. Fire drills are conducted at least once every 6 months, the last drill was completed February 23,2022.

Licensee has ample age-appropriate toys and learning materials inside and outside the home. The outdoor play area is free from defects and dangerous conditions. Per licensee, there are no firearms in the home. Drop-down cribs are not allowed at the day-care facility. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

At 3:15pm, LPA reviewed Children’s files. The facility roster was reviewed, and a copy obtained. All files were organized and complete. The licensee owns the property and does not carry liability insurance. All children’s files contained the LIC282 Notice of no insurance and all were signed and dated. Facility files were also checked and in good order.

Licensee has all required immunizations. CPR/1st Aid was available for licensee and expire on 12/11/2023. Mandated Reporter was completed on 7/7/2021. Licensee was reminded that CPR/1st Aide and Mandated Reporter is to be renewed every two years.

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

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

DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022
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: PULUSU, VISALAKSHMI
FACILITY NUMBER: 013422828
VISIT DATE: 04/20/2022
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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.

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 today. The report will remain on file for three 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 Visalakshmi Pulusu.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2022
LIC809 (FAS) - (06/04)
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