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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423385
Report Date: 12/24/2019
Date Signed: 12/24/2019 11:14:08 AM

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, HARITHAFACILITY NUMBER:
013423385
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/24/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Satish BadepalliTIME COMPLETED:
11:30 AM
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On 12/24/19 at 10:55am, Licensing Program Analysts Briana Plumboy and Junell Chen, met with licensee's husband Satish Badepalli for an UNANNOUNCED CASE MANAGEMENT INSPECTION FOR AN INCREASE IN CAPACITY. The home was toured. The facility currently operates from 8:30am until 6:00pm. The facility received an approved fire clearance from the Union City Fire Department on 12/18/19. Per the fire clearance, "The above facility has been approved. There is no use of any bedrooms, the study room or the garage."

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, ALL 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, hallway bathroom, and center area of the backyard. The ISOLATION AREA will be 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.
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. The licensee's mandated reporter training is complete and she received a certification of completion on 08/30/18.

No deficiencies are being cited. This home is recommended for the capacity increase as of today's date. This report shall remain on file for 3 years. Exit interview conducted. Notice of Site Visit provided and must be posted for 30 days.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2019
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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