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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409881
Report Date: 05/22/2019
Date Signed: 05/22/2019 04:06:27 PM

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:LINGAMPALLI, ADILAKSHMIFACILITY NUMBER:
434409881
ADMINISTRATOR:LINGAMPALLI, ADILAKSHMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 532-1936
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY:14CENSUS: 12DATE:
05/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Adilakshmi LingampalliTIME COMPLETED:
04:15 PM
NARRATIVE
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On 05/22/2019 at 1:45 pm, Licensing Program Analyst (LPA) Araceli Almaraz and Licensing Program Manager (LPM) began conducting an annual random inspection. LPA and LPM met with Licensee,Adilakshmi Lingampalli and explained the nature of today's inspection. Present during the inspection was the licensee and the assistant Ramandeep Bagri. There were 12 children present. The hours of operation of the day-care are 8am to 6 pm Monday to Friday. There are 4 adults residing in the home; Licensee, licensees spouse Rao Lingampalli, two adult children Krishna and Kamal Lingampalli. The licensee has CPR and First Aid, which has an expiration date of 01/2021. The assistant has CPR and First Aid, which has an expiration date of 04/2021. LPA and LPM observed that the Licensee and the assistant have record of MMR & Tdap vaccinations as well as the influenza vaccines. LPA and LPM inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; the upstairs, foray, and part of the dining room and garage. The backyard is fenced and complaint with safety standards. There were no bodies of water observed. LPA and LPM did not observe any heaters in the home. LPA and LPM observed a barricaded fireplace in an off limits area. There is a play area for the children in care, in a part of the living room that is adjacent to the kitchen.. This area is sufficiently barricaded with a sofa and mattress. The LPA and LPM observed a safety gate between the living room and foray area. Medication, cleaning products and similar items are stored inaccessible to children in the laundry room. Poisons shall be locked. LPA and LPM observed a current roster, a current fire disaster/earthquake drills last log is 01/24/2019. Licensee states that there are no weapons in the home. Licensee has no pets in the home. Licensee has no day care insurance. Licensee and assistant have not completed the Mandated Reporter Training. The licensee understands training is to be completed every two years
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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 4
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: LINGAMPALLI, ADILAKSHMI
FACILITY NUMBER: 434409881
VISIT DATE: 05/22/2019
NARRATIVE
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LPA reviewed 12 children's files and observed child one through six needed updated immunization records. The LPA and LPM observed the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA and LPM observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher last serviced 8/28/2018.

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

Supervision of the children was discussed; . The Licensee understands the capacity options and required ratio requirements for the large Family Child Care Home License. Licensee understands not to leave children in the car unattended. The Licensee states that there is no transporting of children currently.



A review of staff records on 05/13//2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12-month period.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: LINGAMPALLI, ADILAKSHMI
FACILITY NUMBER: 434409881
VISIT DATE: 05/22/2019
NARRATIVE
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Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

There are two Type B deficiencies during today’s inspection.

LPA conducted an exit interview with the Licensee appeal rights given and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LINGAMPALLI, ADILAKSHMI
FACILITY NUMBER: 434409881
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/01/2019
Section Cited
CCR
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 provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal
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Licensee and assistant will complete the Mandated Reporter Training on or before 07/01/2019 and send to LPA via email, mail or fax. MandatedReporterCA.com
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mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by LPA and LPM observed licensee and assistant failed to complete the Mandated Reporter Training. This poses a potential risk to the health and safety of the children in care.
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Type B
06/05/2019
Section Cited
CCR
102418(g)(1)
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Immunizations: The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement includes updating each child's PM 286 (6/95)
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Licensee will update records and send evidence of updated immunization recrods to LPA on or before 06/05/2019 via email, mai lor fax.
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when the child is due to receive required immunizations after enrollment in the family day care home. This requirement was not met as evidenced by LPA and LPM observed licensee failed to maintain immunization records for children one through six. This poses a potential risk to the health and safety of children in care.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4