015700110-4-30-2020-52-CC-RRED-BP6U5Z-20200430151735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700110
Report Date: 04/30/2020
Date Signed: 04/30/2020 03:19:17 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:	CHILLARIGE, SAILAJA		FACILITY NUMBER:	015700110
ADMINISTRATOR:	CHILLARIGE, SAILAJA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 918-5659
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	14	CENSUS: 1	DATE:	04/30/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	12:56 PM
MET WITH:	Sailaja Chillarige		TIME COMPLETED:	04:00 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	DUE TO THE COVED-19 SHELTER IN PLACE ORDER BY THE GOVERNOR OF CALIFORNIA, THIS CASE MANAGEMENT, CHANGE OF LOCATION VISIT WAS DONE VIA TELE-VISIT THROUGH FACETIME. Licensing Program Analyst, (LPA) Renee Reed conducted an Announced Case Management Tele- Inspection for a Change of Location, on Thursday, 4/29/2020 at approximately 1:00 PM. Via (FaceTime) LPA Reed toured the residence with licensee, Sailaja Chillarige and conducted a Health and Safety Inspection. Present at the home was licensee's fingerprint cleared husband Srivenugop, adult fingerprint cleared son Sriteja, fourteen and sixteen year old sons as well as, one 22 month old infant. Hours of Operation is Monday thru Friday from 8:00 AM to 6:00 PM Description of Home: The residence is a two story, which consist of 5 bedrooms, 4.5 bathrooms, kitchen, dining room, living room, den and a attached garage. The home is neat and clean with heating and ventilation for safety and comfort. Off Limit Areas:: Entire Upstairs Level and garage. On Limit Areas: The entire ground floor is on limits to children in care, which consist of living room, dining room, kitchen, one bedroom converted to playroom, den converted to activity room, as well as the backyard and side of yard. Isolation Area: Dining room, next to bedroom converted to playroom. The stairway has a child safety gate at the base of the stairs. There is a fireplace which is screened to prevent access by children in care. The facility has a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors (tested and functioning), and a working telephone. Continued 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2020

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: CHILLARIGE, SAILAJA	FACILITY NUMBER: 015700110
	VISIT DATE: 04/30/2020

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Fire Clearance was granted by Dublin Fire Prevention Services on 02/26/2020. There are age appropriate furnishings, toys and equipment in the day care room. The bathroom has working toilet and faucet in new condition. Per licensee, there are no firearms located or stored on the premises. The facility has a fully fenced back yard area, as well as a retaining wall. There is a fire pit with no covering, however Licensee purchased a cover, Licensee will provide photo once cover is received. There are no pools, hot tubs or other accessible bodies of water. Hazardous items/cleaning supplies are stored inaccessible to children in care. All electrical outlets are safety outlets.

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.

LPA Reed provided a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes.

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

This facility is approved for the change of location. A copy of this report was issued to licensee and is to remain in the facility records for a period of three years.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee Reed	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2020

LIC809 (FAS) - (06/04)

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