015700235-4-15-2021-52-CC-LDBX-C24UR4-20210415154807

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700235
Report Date: 04/15/2021
Date Signed: 04/15/2021 03:48:21 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:	KANNAN, VARSHINI & SIVASUBRAMANIAN, RAMANA		FACILITY NUMBER:	015700235
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/15/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Varshini Kannan		TIME COMPLETED:	03:55 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	04/15/2021, at 2:00pm, Licensing Program Analyst (LPA) Lorraine Dacanay-Breaux and Licensing Program Manager (LPM) Chandra Charles, met with applicant Varshini Kannan, for an announced Pre-licensing inspection of her home for a Family day-care license. Present during the inspection was fingerprint cleared husband, Ramana Sivasubramanian, licensee parent's (visiting) Kannan Ramadoss and Kasthuri Kannan and licensee two children ages 8 and 4 years old. The applicant and LPA toured the home inside and outside for a Health and Safety inspection. The applicant stated she will be operating her child-care business Monday through Friday, 8 AM - 5 PM. Applicant’s home is two story Downstairs: a foyer, formal living room has a glass enclosed fire place that is blocked by two bookcases, dining room, (1) bedroom, full size bathroom, office/den, Kitchen with a walk-in pantry, built in desk area, center island with counter top seating, and kitchen dining area. The kitchen area flows into the family room, that includes a glass enclosed fireplace, laundry room and 3 car garage. Upstairs: A loft, master bedroom with a master bathroom, with glass enclosed fireplace, (2) additional bedrooms, (1) additional bathrooms. The backyard is very spacious which consist of a grassy area, concrete areas, gazebo, lock swim spa, and a built in BBQ area. The home is properly ventilated for children's safety and comfort. LPA did not observed any toxins or hazardous materials during the inspection. On Limits areas: Formal Dining and living room(main child care room), first floor bathroom and side yard. Off Limit areas: Entire second floor (inaccessible by barrier gate at the bottom of the stair case), Den/office to the left of entering home, Kitchen, family room, laundry room, bedroom next to bathroom, and 3 car garage. Rear yard and right side of the yard. All areas are inaccessible by locked/closed doors, gates, and visual supervision.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021

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: KANNAN, VARSHINI & SIVASUBRAMANIAN, RAMANA	FACILITY NUMBER: 015700235
	VISIT DATE: 04/15/2021

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
26
27
28
29
30
31
32

Backyard consist of four separate areas: The BBQ area, gazebo area, swim spa area and the seated table area just outside the first-floor patio doors. Applicant advised the day-care children will only have access to the side yard and will access from the main front door leading to a path through the front yard to the gated area. The shed in this area will locked and used for child care purposes. There is a gated area which surrounds the swim spa area in the backyard. LPA observed the swim spa has a locked cover. Throughout the various areas in the backyard there are steps leading to each section.
Per the applicant there is no firearms in the home. The home is equipped with a working carbon monoxide detector, smoking detector and a fully charged (3A10BC) fire extinguisher.

The applicant’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires on 03/27/2023. Mandated Reporter Training is current and expires 02/05/2023. The applicant is following the immunization law which pertains to day care providers. Proof of control of Property was reviewed. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. COVID -19 Prevention was discussed.

Individual Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Home 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.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021

LIC809 (FAS) - (06/04)

Page: 2 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: KANNAN, VARSHINI & SIVASUBRAMANIAN, RAMANA	FACILITY NUMBER: 015700235
	VISIT DATE: 04/15/2021

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
26
27
28
29
30
31
32

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. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov.

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 624B). Incidents must be reported within 24 hours by phone, or fax. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

An exit interview was conducted. Issuing of license is recommended for this home effective today April 15, 2021.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3