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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422987
Report Date: 08/15/2022
Date Signed: 08/15/2022 03:45:00 PM


Document Has Been Signed on 08/15/2022 03:45 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:VATTIPALLI, MAMATHAFACILITY NUMBER:
013422987
ADMINISTRATOR:VATTIPALLI, MAMATHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 289-9209
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:14CENSUS: 9DATE:
08/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Mamatha VattipalliTIME COMPLETED:
03:50 PM
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On August 15th, 2022, Licensing Program Analyst (LPA) April Wright arrived at 1:25pm for an Unannounced Annual/Random Inspection, and met with Licensee Mamatha Vattipalli. Present for this inspection were nine children (9) one (1) infant and eight (8)preschool children , fingerprint cleared assistant Benafsha Baraki. Also residing/present in the home is licensee's son Anish Sarikonda. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation are Monday through Friday, 8:30am to 6:00pm.

ON LIMITS: Kitchen/nook, dining room, living room, first bedroom (Sleep Room) to left in hallway for napping, hallway bathroom, backyard.

OFF LIMITS: Master bedroom/bathroom on first floor, garage, left side yard, entire second floor. Off limit areas are inaccessible by closed and/or locked doors, gates and visual supervision..

The home is two story, which is neat and clean, with heating and ventilation for safety and comfort. The stairway had a child safety gate in place. The outdoor play area is the back patio, which is fenced, and is free from defects and dangerous conditions. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There is fully charged 3A40BC fire extinguisher, working carbon monoxide and smoke detector. The fireplace is not in use and inaccessible to children by a couch and cardboard. Per licensee, there are no firearms in the home.

LPA requested and reviewed the files of nine (9) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The children's roster was reviewed and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 6/1/2022. The licensee has a current Mandated reporter training which was completed on 7/18/2022 and CPR/First aid certificate which expires on 8/13/2024. The licensee is in ratio today. All required forms are posted and visible for public review.



See LIC809C for continuance...
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2022
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: VATTIPALLI, MAMATHA
FACILITY NUMBER: 013422987
VISIT DATE: 08/15/2022
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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail.

Incidental Medical Services (IMS) policy was discussed. No IMS is provided by the licensee. 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

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.

There are no deficiencies cited. A notice of site visit was given and must remain posted 30 days. Exit interview conducted and report was reviewed with Mamatha Vattipalli.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2