<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412643
Report Date: 08/14/2019
Date Signed: 08/14/2019 04:34:08 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:DEVIREDDY, VIJAYAFACILITY NUMBER:
434412643
ADMINISTRATOR:DEVIREDDY, VIJAYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 257-5908
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:14CENSUS: 7DATE:
08/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:32 PM
MET WITH:Vijaya DevireddyTIME COMPLETED:
04:40 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
Licensing Program Analyst (LPA), Marilou Monico, made an unannounced annual random inspection. LPA met with Licensee, Vijaya Devireddy, and explained the nature of today's inspection. Also present in the home were licensee's two adult helpers, Pranitha Kotte and Radhika Kotha, and 7 daycare children including 3 infants, 2 preschool age, and 1 school age. Days and hours of operation are Monday to Friday from 7:00 AM to 6:30 PM. There are three adults living in the home: licensee, her husband, and her daughter.

LPA toured the home both indoor and outdoor. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and orderly. There is a fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detector, barricaded fireplace, barricaded stairs, and no bodies of water. LPA observed an infant sleeping in a car seat in the daycare room. Off limit areas in the home: entire upstairs and garage. Off limit areas outside the home: right side yard. 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. Five children's files and helper's file were reviewed. Licensee maintains a current fire drill log. Licensee does not maintain a current roster of children. Licensee has current CPR/First Aid certifications with an expiration date of May 2020. The home has a working telephone which is (408) 257-5908.

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. Licensee has completed the Mandated Reporter Training.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

(REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 08/14/19):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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 5
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: DEVIREDDY, VIJAYA
FACILITY NUMBER: 434412643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2019
Section Cited
CCR
102370(d)(1)&(2)
1
2
3
4
5
6
7
CRIMINAL RECORD CLEARANCE - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility shall: Obtain a California clearance or a criminal record exemption as required by the Department or Request a transfer of a criminal record clearance.
1
2
3
4
5
6
7
Licensee states she will send transfer request and identification for Radhika to Licensing and submit written Plan of Correction by 08/15/19.

Civil penalty of $600.00 was assessed during the inspection.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Licensee's adult helpers, Radhika Kotha and Pranitha Kotte, have been working at the facility without fingerprint clearances or fingerprint clearances associated to the facility. Radhika started working at 9 AM today and Pranitha has been working for 1 1/2 month. This poses an immediate risk to the health and safety to children in care.
8
9
10
11
12
13
14
Type A
08/15/2019
Section Cited
CCR
102423(a)(2)
1
2
3
4
5
6
7
PERSONAL RIGHTS - Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include: to receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
1
2
3
4
5
6
7
Licensee removed the infant immediately from the car seat. Licensee states she will use mats for children to nap. Written plan of correction to be sent to Licensing by 08/15/19.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: LPA observed an infant sleeping in a car seat. This poses an immediate risk to the health and safety to children in care.
8
9
10
11
12
13
14
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
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: 08/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: DEVIREDDY, VIJAYA
FACILITY NUMBER: 434412643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2019
Section Cited
CCR
102421(a)
1
2
3
4
5
6
7
Child's Records - The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by: Child #1, #3, #5, #6, and #7 have incomplete/missing Licensing paperwork in their files. This poses a potential risk to the health and safety to children in care.
1
2
3
4
5
6
7
Licensee states she will have parents complete/submit all the required Licensing paperwork and send to Licensing by 08/21/19.

Type B
08/21/2019
Section Cited
HSC
102417(g)(8)
1
2
3
4
5
6
7
Operation of a Family Child Care Home - Each family child care home shall have a current roster of children. This requirement is not met as evidenced by: LPA observed that licensee does not maintain a current roster of children. This poses a potential risk to the health and safety to children in care.
1
2
3
4
5
6
7
Licensee states she will submit a copy of current roster of children by 08/21/19.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 08/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: DEVIREDDY, VIJAYA
FACILITY NUMBER: 434412643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2019
Section Cited
HSC
1597.622(1)(1)
1
2
3
4
5
6
7
Employee and Volunteer Immunization - Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. This requirement is not met as evidenced by: Helper #1 is missing immunization in measles, pertussis, and influenza. This poses a potential risk to the health and safety to children in care.
1
2
3
4
5
6
7
Licensee states she will submit copy of her helper's immunizations by 09/13/19.
Type B
09/13/2019
Section Cited
CCR
102369(b)(9)
1
2
3
4
5
6
7
Application for Initial License - Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
1
2
3
4
5
6
7
Licensee states she will submit proof of TB test for her helper by 09/13/19.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Helper #1 is missing TB test. This poses a potential risk to the health and safety to children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 08/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: DEVIREDDY, VIJAYA
FACILITY NUMBER: 434412643
VISIT DATE: 08/14/2019
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
(CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/14/19):

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 with the exception of Licensee's adult helpers, Radhika Kotha (Helper #1) and Pranitha Kotte (Helper #2). Radhika started working today however, her fingerprint clearance is not associated to the facility. Pranitha has been working at the facility for 1 1/2 month with pending fingerprint clearance. 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.

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



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: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5