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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412643
Report Date: 08/28/2019
Date Signed: 08/28/2019 12:08:26 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:DEVIREDDY, VIJAYAFACILITY NUMBER:
434412643
ADMINISTRATOR:DEVIREDDY, VIJAYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 257-5908
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:14CENSUS: 5DATE:
08/28/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Vijaya DevireddyTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs), Marilou Monico and Pete Hernandez, conducted a Plan of Correction (POC) inspection. Licensee was cited on August 14, 2019 under Personal Rights, Criminal Record Clearance, Child's Records, and Operation of a Family Child Care Home. LPAs met with Licensee, Vijaya Devireddy. Present in the home were licensee's adult helper (Radhika Kotha) and 5 daycare children including 3 infants and 2 preschool age. LPAs observed children napping on their mats in the daycare room. Radhika's fingerprint has been transferred to the facility. Current children's roster and missing documents in the children's files were submitted to Licensing on August 20, 2019. LPAs observed completed signed Acknowledgement of Receipt of Licensing Reports (LIA 9224) in the children's files.

Deficiencies under the above sections are hereby corrected and cleared.

There were no deficiencies cited.

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: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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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