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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408350
Report Date: 09/29/2021
Date Signed: 09/29/2021 03:15:03 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:VENUGOPAL, SHOBAFACILITY NUMBER:
073408350
ADMINISTRATOR:VENUGOPAL, SHOBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 378-4978
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:14CENSUS: 1DATE:
09/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Shoba VenugopalTIME COMPLETED:
03:20 PM
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On September 29, 2021, at 2:50pm, Licensing Program Analyst (LPA) arrived unannounced for a case management inspection, and met with licensee Shoba Venugopal. Present was one preschool age child. The purpose of today's inspection was to see if the backyard was ready to be placed back ON-LIMITS. LPA toured the backyard, however, LPA observed the yard is not ready for children to use. LPA will return on a later date to check backyard again.

There are no deficiencies cited today. The backyard remains OFF-LIMITS.

Exit interview conducted with licensee Shoba Venugopal. Copy of report provided. Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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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