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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313433
Report Date: 03/10/2020
Date Signed: 03/10/2020 01:30:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GOVINDASWAMY, MOHANAPRIYAFACILITY NUMBER:
304313433
ADMINISTRATOR:GOVINDASWAMY, MOHANAPRIYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 923-1197
CITY:IRVINESTATE: CAZIP CODE:
92602
CAPACITY:14CENSUS: 12DATE:
03/10/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Mohanapriya GovindaswamyTIME COMPLETED:
02:00 PM
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A Plan of correction (POC) inspection was conducted by LPA Valencia. Today's POC inspection is being conducted in response to a 1 year Annual inspection conducted on 3/3/20, in which two A violations were cited. During the inspection on 3/3/20, it was observed by LPA that 12 preschool age children were in care, and the licensee did not have an assistant helping with supervision. LPA also observed that the staircase to the upstairs of the home was accessible and not barricaded. Two A violations were cited, and a plan of correction was discussed. It was discussed that the licensee would have her spouse always present assisting with care, until an adult assistant is hired and this plan will be submitted to LPA via email. This was submitted to LPA on 3/3/20.

During today's inspection the LPA was present at the facility to verify that the facility has corrected the A violation and has followed through with the plan discussed to correct the violation, and remain within compliance of capacity and ratio regulations. During today's inspection, it was observed that 12 preschool children were in care and the spouse was present assisting the licensee with care. Also observed was the staircase barricaded with a baby gate It was observed that the facility has corrected the violations and licensee understands that she is to remain within compliance of the ratio and capacity regulations, at all times. In addition to this report being given to the licensee, a print-out of ratio regulations was discussed and given to the licensee.

Notice of Site Visit was provided for the licensee and advised that it must be posted for 30 days.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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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