376100955-12-21-2021-51-CC-SSIO-C9WPZR-20211221104559

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100955
Report Date: 12/21/2021
Date Signed: 12/21/2021 01:16:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	THYAGARAJAN, SRIVIDYA FAMILY CHILD CARE		FACILITY NUMBER:	376100955
ADMINISTRATOR:	SRIVIDYA THYAGARAJAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 740-6984
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92129
CAPACITY:	14	CENSUS: 0	DATE:	12/21/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Srividya Thyagarajan		TIME COMPLETED:	10:50 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/21/2021 at 9:30am, Licensing Program Analyst (LPA), Selina Siao conducted a scheduled change of location pre licensing inspection with applicant via Face Time. Applicant was previously licensed with facility number 376628247. The 5 bedroom 3 bath, 2 stories house was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fully charged fire extinguisher size 3A40BC, smoke and carbon detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children during the inspection. The home does not have any bodies of water. Applicant stated that the home does not have any weapon. Applicant's EMSA approved pediatric CPR and First Aid cards are current due to expire on 11/07/2022 and she completed the mandated child abuse training on 11/02/2021. A review of the application and records on this date indicates that applicant, her husband and their two adult daughters are the current adult residents at the home with the require TB clearances, caregiver background checks and child abuse clearances. Applicant has the required measles and pertussis immunizations. Applicant and her husband owns the property and has provided a copy of the grant deed as proof. Applicant will be using the following areas for childcare: living room, formal dining area, kitchen, dining area, family room, laundry area, bedroom and bathroom located downstairs. Off limit areas includes: garage and all of upstairs by having a door knob cover and safety gate at the bottom of the stairs. The family room has a fire place with a glass door that has a safety latch to prevent children's access. Outdoor area is the fenced backyard and visual supervision is required when children are outside. The isolation area will be the bedroom. Applicant was reminded of requirements for children’s records, facility roster, child abuse and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties of $100 per day, car seat law, shaken baby syndrome, and SIDS.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: THYAGARAJAN, SRIVIDYA FAMILY CHILD CARE	FACILITY NUMBER: 376100955
	VISIT DATE: 12/21/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Applicant was reminded that corporal punishment, smoking, baby walkers, exersaucers, bouncy seats and baby jumpers are not allowed in day care. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

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

Applicant shall comply with all regulations and laws governing family childcare homes and be financially secure to operate a family childcare home for children.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at www.ccld.ca.gov . LPA discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. Applicant was provided with the latest PIN 21-29 face covering requirements and guidance for child care providers.

The home appears to be within compliance pending a fire clearance for a large license. Applicant has an appointment with the fire inspector today at 11:30am.

LPA read the report to applicant today and a copy of the report will be email to her. Applicant will reply to the email indicating that she received the report which will serve as her signature.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2