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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409388
Report Date: 06/19/2019
Date Signed: 07/02/2019 03:29:00 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MAMIDIPAKA, SRILAKSHMIFACILITY NUMBER:
434409388
ADMINISTRATOR:MAMIDIPAKA, SRILAKSHMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 739-9855
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 7DATE:
06/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Srilakshmi MamidipakaTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analyst (LPA), Marilou Monico, made an annual random inspection. Present in the home were licensee, her husband, her 15-year-old daughter/helper, her 17-year-old son, and 7 daycare children including 4 infants and 3 preschool age. Days and hours of operation are Monday to Friday from 8:30 AM to 6:30 PM. There are two adults living in the home: licensee and her husband.

LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean. There is a fully charged 3A40BC fire extinguisher, working smoke detector, functioning carbon detector, glass covered fireplace, and no bodies of water. Off limit areas in the home: 3 bedrooms, 1 bathroom, kitchen, furnace closet, and garage. No off limit areas outside the home. Medications, cleaning compounds, sharp objects, and other similar items are stored out of reach of children. Per licensee, there are no weapons in the home. Seven children's files were reviewed. Licensee maintains a current children's roster. LPA obtained copy of children's roster. Licensee has current CPR/First Aid certifications with an expiration date of June 23, 2020.

LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. AB 633 was discussed with Licensee. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. LPA provided licensee with lead safety information sheets and advised her to provide copies to parents.

A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemption.

As a result of this inspection, deficiencies were cited on the following page:

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MAMIDIPAKA, SRILAKSHMI
FACILITY NUMBER: 434409388
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2019
Section Cited
HSC
1596.8662(b)(1)
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MANDATED REPORTER TRAINING - On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training and shall complete renewal every two years following the date on which he or she completed the initial mandated reporter training.
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Licensee states she will submit proof of completion for her and her daughter by 07/19/19.
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This requirement is not met as evidenced by: LPA observed that licensee and her daughter have not completed the Mandated Reporter Training. This poses a potential risk to health and safety to children in care.
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Type B
06/26/2019
Section Cited
CCR
102417(g)(9)(A)(1)
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OPERATION OF A FAMILY CHILD CARE HOME - Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by: LPA observed that the last fire drill was conducted on 11/10/17. This poses a potential risk to the health and safety to children in care.
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Licensee states she will practice fire/disaster drill with the children and will send documentation to Licensing by 06/26/19.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2