013423385-11-21-2019-52-CC-BPLY-BJ5SZ5-20191121131835

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423385
Report Date: 11/21/2019
Date Signed: 11/21/2019 01:18:40 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:	BADEPALLI, HARITHA		FACILITY NUMBER:	013423385
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	11/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:18 PM
MET WITH:	Haritha Badepalli		TIME COMPLETED:	01:35 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 11/21/19 at 12:18pm, Licensing Program Analyst Briana Plumboy, met with licensee Haritha Badepalli for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was assistant Monika Naik and 5 preschool age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 8:30am until 6:00pm. The home is single story. The home consists of a kitchen, living room, family room, 3 bedrooms, 1 hallway bathroom, a master bedroom and bathroom, garage, and backyard. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the kitchen, 3 bedrooms, a master bedroom with a master bathroom, the left and right side of the backyard, and the garage which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, family room, the bedroom located off of the living room, hallway bathroom, and center area of the backyard. The ISOLATION AREA will be the bedroom located off of the living room. There is a safety gate located between the living room and kitchen, as well as across the door which leads to the garage. There is also a child safety knob cover on the door knob of the garage to prevent access to children in care. Outdoor play area will be located inside the backyard. The backyard is fenced. There are ample age appropriate toys that appear to be safe and in good condition during today's inspection. There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children and it was observed that during the inspection there are no toxins or hazardous items accessible to children in care. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee CPR and First Aid certificate is current and expires 04/07/20 and her assistant has a valid CPR and First Aid certificate which expires 07/13/21. The licensee's mandated reporter training is complete and she received a certification of completion on 08/30/18, and her assistant currently has a waiver for the training and the licensee is aware when it is available in her assistant's native language she must take the training. The licensee and her assistant are in compliance with the immunization law which pertains to childcare providers. The fireplace is located inside the family room and is screened and barricaded to prevent access by 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: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

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: BADEPALLI, HARITHA	FACILITY NUMBER: 013423385
	VISIT DATE: 11/21/2019

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children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills more than twice a year with the last earthquake conducted on 07/14/19 and the last fire drill conducted on 10/14/19.
(2) Children files were reviewed. 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
Per licensee there are no children at this time who are requiring IMS

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: 11/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019

LIC809 (FAS) - (06/04)

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