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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700235
Report Date: 05/27/2022
Date Signed: 05/27/2022 10:14:11 AM


Document Has Been Signed on 05/27/2022 10:14 AM - It Cannot Be Edited

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,VARSHINIFACILITY NUMBER:
015700235
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Varshini KannanTIME COMPLETED:
10:20 AM
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On May 27, 2022, at approximately 8:40 am, Licensing Program Analyst (LPA) Simerjit Kaur arrived at the facility unannounced to conduct a CASE MANAGEMENT INCREASE IN CAPACITY INSPECTION. LPA met Licensee Varshini Kannan. Present during today's visit was the a fingerprint cleared assistant Theivarani Anbarsan and 3 preschool age children. Also residing in the home is licensee’s husband and 2 children (9 years old daughter and 4 year old son). Hours of operation for child care are Monday through Friday, 8:30am to 5:30pm. The facility is a double story house. LPA conducted a health and safety inspection of the facility.
ON LIMIT AREAS (accessible to children in care): Formal Dining/playroom, living room/ classroom, first floor bathroom and left side yard.
OFF LIMIT AREAS (not accessible to children in care): Entire second floor (3 bedroom/ 2 bathroom), office located next to main entrance, kitchen, family room, bedroom located next bathroom on first floor, rear yard, right side of yard, and garage. There is hot tub located in off limit area of the yard. OFF Limit areas are inaccessible by closed and/or locked doors and visual supervision. The home is clean, safe, sanitary and in good repair. The home has a 3A40BC fire extinguisher, working smoke detector and carbon monoxide detector. The Licensee was reminded to follow fire clearance conditions: the garage and second floor is not permitted for day care use. Licensee is also reminded that if no assistant provider is present at Large Family Child Care Home, then the licensee should comply with the capacity requirements for a Small Family Child Care Home. LPA reviewed staff file and mandated reporter training completed on 11/27/21. Required documents are in file.
The fire clearance for the increase in capacity was received and approved on 05/23/2022.
No deficiencies are being cited. This home is recommended for the Large Family Child Care Home as of today's date 5/27/2022. This report shall remain on file for 3 years. Exit interview conducted with licensee Varshini Kannan. Notice of Site Visit provided and must be posted for 30 days.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:
DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2022
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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