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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803735
Report Date: 10/15/2021
Date Signed: 10/15/2021 09:36:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KUPPANDA FAMILY CHILD CAREFACILITY NUMBER:
334803735
ADMINISTRATOR:KUPPANDA, VIREENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 371-8650
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:14CENSUS: 7DATE:
10/15/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Vireena Kuppanda, Licensee
Suresh Kuppanda, Licensee		TIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) arrived at the facility to conduct a Case Management inspection in response to the receipt of a modified Decision & Order (D&O) adopted on October 4, 2021. A tour of the facility inside & outside and census were taken. During today’s inspection LPA reviewed the D&O with the Licensee. The Licensee understands the facility will be on probation for three years and must adhere to the following conditions:
  • Respondents shall not care for children under the age of two (2)
  • Must have additional staff when caring for twelve (12) children
  • Notice of any violations within 24 hours and in writing within 72 hours
  • Respondents shall submit written reports every 6 months during the 3 year probationary period Respondents shall take all courses by the Department for new Applicants.
  • Respondents must enroll within 30 days of the stipulation and must complete them within 90 days. After 1 year has passed of the completion, they must take refresher courses in the areas of: Reporting Requirements, Personal Rights, and sleep/care of infants.

Licensee also understands the authorized representative(s) for children enrolled must be given a copy of the full D&O and have them sign an LIC 9224 Acknowledgment of Receipt of Licensing Reports (LIC 9224). The
LIC 9224 must be maintained in the child’s file for 12 months. All children within the next 12 months must receive a copy of the full D&O and their representative(s) must also sign an LIC 9224 which must be placed in the child’s file.

An exit interview was conducted. A copy of this report, a copy of the D&O adopted on October 4, 2021 and a Notice of Site Visit was provided to the Licensee.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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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