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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422987
Report Date: 06/05/2024
Date Signed: 06/05/2024 12:09:28 PM


Document Has Been Signed on 06/05/2024 12:09 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: 11DATE:
06/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mamatha VattipalliTIME COMPLETED:
12:05 PM
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On June 5, 2024 at 9:45am, Licensing Program Analyst (LPA) April Wright arrived for an Unannounced Annual/Random Inspection, and met with Licensee Mamatha Vattipalli. Present during the inspection were eleven (11) children (9 preschool and 2 infant age) and fingerprint cleared assistant Benafsha Baraki. 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.
The two story home consists of three (3) bedrooms, three (3) bathrooms including master bathroom, kitchen, backyard and garage. The home was neat and orderly with heating and ventilation for safety and comfort of children in care. There is a child safety gate in place at the bottom of the staircase to prevent access to the second level of the home. LPA observed and Licensee confirmed that there are no pools, hot tubs or any bodies of water present in the home.

ON LIMITS: First level of the home: Living Room/Dining area (Daycare areas) Kitchen/nook, first bedroom (bedroom #1 - Sleep Room) left of hallway for napping only, hallway bathroom (right of hallway) and right portion of the backyard. Isolation area for sick children is in the living room area on couch, chair or sleep mat/cot.


OFF LIMITS: Second level of the home: Master bedroom(bedroom#3) /bathroom, bedroom #2(first level to right of hallway before garage), garage, left side backyard. Off limit areas are made inaccessible by closed and/or locked doors, child safety gates and visual supervision by Licensee and assistant.
Outdoor play area is fenced and LPA observed there was no damage or hazards visible. There are age appropriate toys and furniture that LPA observed to be safe and in good condition. LPA observed and Licensee confirmed that are no toxins, medicines, cleaning products or hazardous materials visible and were inaccessible to children in care during today's inspection. There is fully charged 3A40BC fire extinguisher, working carbon monoxide/smoke detectors. The fireplace is not in use per Licensee and is blocked by a wood plank which makes it inaccessible to children in care. Per licensee, there are no firearms or weapons in the home. See LIC809C for continuance.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024
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: 06/05/2024
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All individuals subject to criminal record review have a clearance or exemption and have been associated to the this FCCH. LPA requested and reviewed the files of eight (8) 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 5/10/2024. The licensee and assistant have current Mandated reporter training which was completed on 7/18/2022 and CPR/First aid certificate which expires on 8/13/2024 for the licensee and 7/9/2024 for their assistant. The licensee is in ratio today. All required forms are posted and visible for public review upon entry to the home.

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

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/.

See LIC809C for continuance.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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: 06/05/2024
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During the exit interview, the Licensee Vattipalli, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Mamatha Vattipalli
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
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