013423369-12-5-2019-52-CC-BPLY-BJKUL8-20191205144019

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423369
Report Date: 12/05/2019
Date Signed: 12/05/2019 02:40:25 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:	BADAM, HARIKA		FACILITY NUMBER:	013423369
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	12/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:03 PM
MET WITH:	Harika Badam		TIME 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	On 12/05/19 at 2:03pm, Licensing Program Analysts Briana Plumboy and Elimika Woods, met with licensee Harika Badam for an UNANNOUNCED RANDOM INSPECTION AND INCREASE IN CAPACITY INSPECTION. Present for this visit was 3 infants and 2 preschool age children. Also present is licensee's mother in law Padmavathi Gokavarapu who is visiting from out of the country. LPAs reviewed Padmavathi Gokavarapu the plane ticket to and from the USA. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:30am until 6:00pm. The home is two levels. The home consists of a living room, kitchen, dining room, family room, a sun room, an outside storage room, 2 bathrooms, 3 bedrooms, a master bedroom with a master bathroom, and a garage. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the backyard, storage room located on the left side of the backyard, the entire second level of the home, and the garage which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, dining room, family room, kitchen, sun room, and downstairs bathroom. Per the fire clearance, Per the fire clearance which was approved on 12/02/19 by the Union City Fire Department, Fire clearance approved for use of first floor ONLY. No Daycare activity allowed on second floor or in the garage at anytime. The ISOLATION AREA will be the living room. There is a gate located at the bottom of the stairs. There is also a gate located between the family room, living room, and kitchen. Outdoor play area will be in the front yard and licensee is aware there must be 100% visual supervision at all times. There are 2 bird baths and a fountain located inside the backyard. The backyard is off limits to children in care. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible to children in care during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, pull down fire alarm, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires 09/08/20. The licensee's mandated reporter training is complete and she received a certification of completion on 08/14/18. The See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

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: BADAM, HARIKA	FACILITY NUMBER: 013423369
	VISIT DATE: 12/05/2019

NARRATIVE

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licensee is in compliance with the immunization law which pertains to daycare providers. Per licensee, there are no firearms in the home. The fireplace is barricaded and located behind a couch to prevent access by children, and is located inside the living room. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 08/21/19. (5) Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

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

LPA Plumboy provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 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. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care. 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

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

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019

LIC809 (FAS) - (06/04)

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