393621373-5-25-2021-53-CC-BENN-C3DL6T-20210526082915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 393621373
Report Date: 05/25/2021
Date Signed: 05/25/2021 05:16:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/01/2021 and conducted by Evaluator Stacey Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 53-CC-20210301161236

FACILITY NAME:	VANKAYALA, KAVITHA		FACILITY NUMBER:	393621373
ADMINISTRATOR:	VANKAYALA, KAVITHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 594-5002
CITY:	MOUNTAIN HOUSE	STATE: CA	ZIP CODE:	95391
CAPACITY:	14	CENSUS: 8	DATE:	05/25/2021
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Kavitha Vankayala		TIME COMPLETED:	10:21 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Day care child sustained injury while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Due to the COVID-19 pandemic, Licensing Program Analyst (LPA) Stacey Williams conducted a Tele-Visit via WhatsAPP with Licensee, Kavitha Vankayala in lieu of conducting an onsite inspection regarding the above complaint allegation. There were 8 children supervised by the Licensee and 2 staff at the time of the inspection.
LPA Williams conducted interviews with the Complainant, Licensee and Licensee’s Assistants. Facility records, medical records and photos were gathered to assist with the investigation. It was alleged that Child#1(C1) sustained an injury while in care. Licensee denied the allegation. Information gathered revealed that it was C1’s first day at the Licensee’s childcare. Licensee acknowledged C1 was upset after the initial drop off and had difficulties transitioning into childcare away from home; however, was not injured while in her home. All individuals interviewed confirmed C1was visibly upset; however, there was no evidence presented indicating C1 was injured while in the Licensee’s home. Based on the evidence provided during the investigation, the allegation is determined to be unsubstantiated.
An exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the Licensee, Kavitha Vankayala, whose signature on this form confirm receipt of these documents. Notice of Site Visit was provided for the Licensee to post during today’s inspection.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

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

LIC9099 (FAS) - (06/04)

Page: 1 of 1