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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423369
Report Date: 08/02/2022
Date Signed: 08/02/2022 02:27:14 PM


Document Has Been Signed on 08/02/2022 02:27 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:BADAM, HARIKAFACILITY NUMBER:
013423369
ADMINISTRATOR:HARIKA BADAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(812) 361-7599
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 9DATE:
08/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Harika BadamTIME COMPLETED:
02:40 PM
NARRATIVE
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On 08/2/22 at 1:07pm, Licensing Program Analyst Briana Plumboy met with licensee Harika Badam for an UNANNOUNCED REQUIRED ANNUAL INSPECTION. Present for this visit was 4 infants, 4 preschool age children, and 1 school age child (licensees daughter). Also present is licensee's fingerprint clear and associated assistant Harjot Kaur and fingerprint clear and associated husband Harish Gokavarapu. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:30am until 5:30pm.

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 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. As of 8/31/21, the left side and base section of the backyard is included in the on limit areas. 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 the backyard. The licensee is aware there must be 100% visual supervision at all times in the front yard. There is an anchored swing set located in the backyard. Licensee is aware the backyard must remain free from hazards at all times. There is a hammock attached to two trees and a swing hanging from a tree during today's inspection and licensee is aware the children in care may not be on them at any time. There is also an infant swing hanging from a wooden post which licensee is aware may not be used by children in care at anytime.
The home has a fully charged 2A10BC fire extinguisher, working smoke detector, pull down fire alarm, working carbon monoxide detector, and working telephone. The licensee and assistant present during today's inspection are both in compliance with the immunization law. The licensee's CPR and First Aid certificate is current and expires 06/12/23. The licensee's mandated reporter training is complete and she received a certification of completion on 06/10/21, and assistant Harjot Kaur's employee file is complete and she received a certificate of completion in mandated reporter training on 06/10/21. The See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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: 08/02/2022
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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 encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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



LPA discussed the safe sleep regulations with licensee Harika Badam 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 Harika Badam 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.

A notice of site visit was given and must remain posted for 30 days.

See 809-D for deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Harika Badam.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/02/2022 02:27 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to the last documented drill was July 2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2022
Plan of Correction
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Licensee stated she will conduct a disaster drill and send LPA Plumboy a picture of her disaster drill log documenting a drill conducted today.
Type B
Section Cited
CCR
102425(i)
Infant Safe Sleep
If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 out of 8 children in care were sleeping in rockers which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2022
Plan of Correction
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Licensee moved the children out of the rockers when she was informed by LPA Plumboy the children could not sleep in the rockers.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
LIC809 (FAS) - (06/04)
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