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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005472
Report Date: 04/30/2024
Date Signed: 04/30/2024 12:40:43 PM

Document Has Been Signed on 04/30/2024 12:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PALMEIRA MUMMANENI, ADRIANAFACILITY NUMBER:
214005472
ADMINISTRATOR/
DIRECTOR:		PALMEIRA MUMMANENI ADRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 686-4282
CITY:MILL VALLEYSTATE: CAZIP CODE:
94941
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
04/30/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Licensee, Adriana Palmeira MummaneniTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
NARRATIVE
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On 4/30/2024, at approximately 9:20AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Licensee, Adriana Palmeira Mummaneni (L1). LPA explained the purpose of the visit. Present during the visit were L1, two helpers, two preschool age children, and four infants. The facility is in compliance with staffing and ratio requirements on this day.

Daycare Areas: Nursery, Classroom, Bedroom #1 (napping only), Bedroom #2 (napping only), Backyard, Front Yard.
Off-limits Area: Kitchen, Living Room, Bathroom #1, Bathroom #2, Storage Shed in the Backyard, and Garage.

LPA inspected the home for any health and safety hazards. LPA observed the home to be in clean and orderly condition. The home is equipped with a fully charged 2A10BC fire extinguisher. There is a functioning carbon monoxide detector present in the Classroom. LPA observed age-appropriate toys and learning materials in the Classroom. There is a diaper changing station that is cleaned daily. Electrical outlets are covered or obstructed by furniture to be inaccessible to children in care. The facility provides water bottles for children in care. The facility provides breakfast, lunch, and snacks. Per L1, there are no firearms or weapons in the home.

LPA observed the Backyard to be free of debris and other loose articles. The Backyard is enclosed by a fence that is at least four feet high. There are age-appropriate toys and equipment for children in care. There are slides that are cushioned by mats that provide resilient padding. There are no pools or other bodies of water in the facility.


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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PALMEIRA MUMMANENI, ADRIANA
FACILITY NUMBER: 214005472
VISIT DATE: 04/30/2024
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LPA reviewed three personnel records, five children’s files, and facility records. Licensee’s First Aid/CPR expires 2/2026. LPA discussed Mandated Reporter Training requirements with Licensee. Licensee stated that she understood. LPA observed all children’s files to contain Emergency Identification and Information (LIC700) and Notification of Parents’ Rights (LIC995A). LPA observed all required postings to be posted and accessible for review. LPA reminded Licensee to document their last emergency drill. Licensee agreed.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/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.





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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PALMEIRA MUMMANENI, ADRIANA
FACILITY NUMBER: 214005472
VISIT DATE: 04/30/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited during today’s visit on 4/30/2024.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Adriana Palmeira Mummaneni.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
LIC809 (FAS) - (06/04)
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