434409881-5-24-2023-07-CC-FRAA-CS5TYZ-20230524150933

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409881
Report Date: 05/24/2023
Date Signed: 05/24/2023 03:09:42 PM

Document Has Been Signed on 05/24/2023 03:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LINGAMPALLI, ADILAKSHMI		FACILITY NUMBER:	434409881
ADMINISTRATOR:	LINGAMPALLI, ADILAKSHMI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 532-1936
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	05/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Adilakshmi Lingampalli		TIME COMPLETED:	02:15 PM

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 05/24/2023 at 11:35am, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Adilakshmi Lingampalli and explained the nature of today’s inspection. Present in the home were licensee, three (3) infants and three (3) preschool age children. Licensee was operating within the ratio and capacity requirements of her license. Days and hours of operation are Monday to Friday, 8:00 am to 6:00 pm. LPA observed all required posted materials in the family room of the home. The adults that reside in the home are Licensee, Spouse and one adult daughter. Licensee states that one adult son visits occasionally. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-532-1936). LPA observed sufficient materials, toys, and play equipment for the day care children. The floors were free of tripping hazards with toys put away in bins. The home has central heating/cooling and ventilation for comfort of children. The home is two story and LPA observed barricaded stairs during today's inspection. Off limit areas inside the home: entire upstairs, downstairs(living room, one bedroom, laundry room and kitchen),attached garage and barricaded fireplace in the on-limits family room. Off limit areas outside the home: left side section and garden bed. Backyard is fenced and both sides of the home are gated. There are no bodies of water observed. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are operable. All detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children. LPA observed a fully charged 3A40BC fire extinguisher in the kitchen area and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. Licensee understands that smoking is prohibited in the home. Drinking water is readily available for children in the home via individual water bottles. Licensee states that she provides breakfast, lunch and two snacks to the children in care. Parents provide snacks and milk for their children. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LINGAMPALLI, ADILAKSHMI	FACILITY NUMBER: 434409881
	VISIT DATE: 05/24/2023

NARRATIVE

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LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on 02/01/2023. LPA obtained copy of children's roster. Children file review was completed and found to be current and up to date. Six (6) children’s files were reviewed during today's inspection. Licensee does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). LPA reviewed three (3) infant children's files and the files were complete with the required forms, including 15-minute checks for each infant. LPA provided Safe Sleep website:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

Staff file review was completed and found to be current and up to date. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee has current Pediatric CPR/First Aid certification with an expiration date of 02/11/2025. Licensee has proof of immunization in file for measles, pertussis and influenza vaccine. Licensee's Mandated Reporter Training expires on 01/13/2025. Licensee understands the training is mandatory to all licensees, and adults in the home, in contact will children, and requires renewal every two years.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. 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.

Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LINGAMPALLI, ADILAKSHMI	FACILITY NUMBER: 434409881
	VISIT DATE: 05/24/2023

NARRATIVE

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LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc.

Licensee states that a child will be isolated in a separate area of the family room if necessary due to illness or communicable disease. Licensee states that she does not administer any medications to the day care children at this time. LPA provided Licensee with a copy of PIN 22-02. 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 Americans with Disabilities Act (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.

The Licensee states that she does not transport any day care children. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

As a result of today's inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with the Licensee, Adilakshmi Lingampalli .

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dess.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

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