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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423062
Report Date: 08/03/2021
Date Signed: 08/03/2021 03:45:53 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:AMBA BHAVANI LLC/DBA KEEN LEARNERS MONTESSORIFACILITY NUMBER:
013423062
ADMINISTRATOR:AMBERKER, KSHAMA N.FACILITY TYPE:
840
ADDRESS:38660 LEXINGTON ST.TELEPHONE:
(510) 396-2403
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:30CENSUS: 0DATE:
08/03/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Kshama AmberkerTIME COMPLETED:
03:50 PM
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On August 3 2021 at approximately 2:50pm, Licensing Program Analyst (LPA) Haderer made an announced case management visit to review the facility and classrooms (kindergarten and elementary school room). LPA met with site director Kshama Amberker. There were two other fingerprint cleared teachers present today.

Repair work was required for a minor electrical fire in the upstairs bathroom light fixture. Due to the fire sprinkler system engaging, there was water damage to the classroom floors (carpeting). The classrooms had to be dried out and new carpet installed.

LPA toured the facility and classrooms. He noted new carpet has been installed throughout all classrooms. The classrooms (Kindergarten and elementary school room) are being prepared and will be ready to accept students again starting August 5, 2021.

The work that has been carried out meets the requirements to allow the facility to resume operations and accept children back into care.

LPA left facility at 3:40PM.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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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