015700012-7-25-2019-52-CC-MGUT-BEEU67-20190725151753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700012
Report Date: 07/25/2019
Date Signed: 07/25/2019 03:18:05 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:	THONDAPU, LAKSHMI		FACILITY NUMBER:	015700012
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	07/25/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Lakshmi Thondapu		TIME COMPLETED:	03:30 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 07/25/2019, Licensing Program Analysts Guirit and Chew, met with applicant Lakshmi Thondapu for an ANNOUNCED PRE LICENSING/RE-LOCATION INSPECTION. Present for this inspection was applicant and applicant's fingerprint cleared husband Chandra Mathamsetty. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are 8:30 AM to 6:00 PM. The home is a tri-level home . The home consists of 5 bedrooms, 3 bathrooms, living room, dining room, kitchen, front yard, and backyard. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the entire 2nd and 3rd levels of the home which will be inaccessible by closed and/or locked doors, child barricade, and visual supervision. The ON LIMIT AREAS are the backyard,and the 2 bedrooms and bathroom on the bottom level. The ISOLATION AREA will be in the bedroom on the bottom floor which is the children's classroom. Outdoor play area will be the backyard which is entirely fenced and supervision will be provided. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of toys and activities available for children, and they are in good condition and age appropriate. There is a small fountain in the backyard that is empty and not working. Applicant is aware that fountain must be kept empty at all times. 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 today. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. The applicant’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 09/2020. Applicant completed the Mandated Reporter Training which expires on 07/2021. The applicant is in compliance with new immunization law which pertains to day care providers. Per applicant, there are no firearms in the home. A copy of the property tax statement was reviewed and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. See 809 - C for continuance.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019

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: THONDAPU, LAKSHMI	FACILITY NUMBER: 015700012
	VISIT DATE: 07/25/2019

NARRATIVE

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Applicant 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 .http://www.myccl.gov/

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

This home will remain pending per manager approval. This report shall remain on file for 3 years. Exit interview conducted applicant.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019

LIC809 (FAS) - (06/04)

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