073408350-11-9-2021-52-CC-JPLA-C8LQL8-20211109111532

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408350
Report Date: 11/09/2021
Date Signed: 11/09/2021 11:15:49 AM

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, SHOBA		FACILITY NUMBER:	073408350
ADMINISTRATOR:	VENUGOPAL, SHOBA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 378-4978
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94583
CAPACITY:	14	CENSUS: 2	DATE:	11/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Shoba Venugopal		TIME COMPLETED:	11:25 AM

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On November 9, 2021 at 9:00am, Licensing Program Analyst (LPA) Julia Placencia arrived at the facility unannounced to conduct a Required-1 Year Inspection. LPA met with licensee Shoba Venugopal. Also residing in the home is the licensee’s husband Venu Gopal, and daughters Hima Bindu and Poorvi Venugopal. The facility is a one story single family home. Hours of operation for child care are Monday through Friday, 7:00am to 7:00pm. The following was observed during today’s inspection:

Capacity/Staffing: The facility operates as a Family Child Care Home (large), which may have a maximum capacity of twelve (12) to fourteen (14) children. At time of inspection, there were two preschool age children in care. The facility is in compliance with ratio and capacity limitations.

ON Limit areas (accessible to children in care): Family Room, Living Room, Dining/Activity room, Kitchen, Hallway Bathroom. LPA observed the facility to have heating and ventilation for safety and comfort. There are ample age appropriate toys that are observed to be safe and in good condition. LPA did not observe any dangerous conditions, nor any hazardous or toxic items accessible to children in the ON Limit areas of the facility today.

OFF Limit areas (not accessible to children in care): Bedrooms, Garage, Backyard. The backyard has an underground swimming pool which is surrounded by a five foot high fence. OFF Limit areas are inaccessible by closed and/or locked doors and visual supervision. Licensee is advised to contact Licensing so that an inspection can be completed prior to changing an OFF Limit area to ON Limit.

Emergency Preparedness/Safety: Facility has a fully charged 3A40BC fire extinguisher. Smoke and carbon monoxide detectors were tested and found to be functioning. First aid supplies are available. Facility has phone service. Per licensee, there are no firearms in the home. Licensee confirmed Emergency Disaster Plan on file to be current (dated 10/12/17).

***Continued on LIC 809C...

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

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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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: VENUGOPAL, SHOBA	FACILITY NUMBER: 073408350
	VISIT DATE: 11/09/2021

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Staff Records Review: Licensee and all adults living and/or working in the home have proper criminal background clearances. Licensee has a Covid-19 Waiver for CPR/First Aid training. Licensee’s mandated reporter training expired on 12/1/20. Licensee is in compliance with immunization law.

Children’s Records Review: All required licensing documents were observed. Facility does not have Liability Insurance and Affidavits are in each child’s file. A facility roster is maintained.

Licensing Postings: Facility license, Notification of Parents’ Rights, Earthquake Preparedness, Emergency Disaster Plan, Covid-19 Waiver Attestation Form for Pediatric CPR/1st Aid Certification.

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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

***Continued on LIC 809C...

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

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: VENUGOPAL, SHOBA	FACILITY NUMBER: 073408350
	VISIT DATE: 11/09/2021

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Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

There are no deficiencies cited during today's inspection. Please see LIC 9102 for Advisory Notes.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Shoba Venugopal.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC809 (FAS) - (06/04)

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