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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412643
Report Date: 07/30/2021
Date Signed: 07/30/2021 03:01:12 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: 3DATE:
07/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Vijaya DevireddyTIME COMPLETED:
03:15 PM
NARRATIVE
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#2 Licensing Program Analyst (LPA), Marilou Monico, conducted a Required - 1 Year inspection. LPA met with Licensee, Vijaya Devireddy, and explained the purpose of today's visit. Also present in the home were three preschool age daycare children. There are three adults residing in the home: licensee, her husband, and her daughter. The home is a two-storey with four bedrooms and 3 bathrooms. The daycare is open Monday to Friday from 8:30 AM to 6:00 PM.

LPA toured the home inside and out with the Licensee. LPA observed sufficient toys and play equipment for the day care children. Bathroom used by children was observed to be clean and in good condition.

Off limit areas in the home: entire upstairs and garage. Off limit areas outside the home: right side yard. There were no bodies of water observed. Per Licensee, there are no weapons in the home. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke and carbon monoxide detector, barricaded stairs, barricaded fireplace, and fenced backyard. Cleaning compounds, detergents, medications, sharp objects, and other similar items were stored inaccessible to children.

LPA reviewed three children's files. A copy of current children's roster was obtained. LPA discussed with Licensee 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. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Mandated Reporter Training (AB1207) for licensee is expired. Licensee has current Pediatric CPR that was taken online with an expiration date of May 16, 2022. Licensee's First Aid is expired. LPA advised licensee to complete the in-person Pediatric CPR/First Aid training and proof of completion to be sent to Licensing.

Continuation on next page:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
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 3
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: 07/30/2021
NARRATIVE
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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 exemptions.

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensees are encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.
LPA reviewed with Licensee and provided a copy of Safe Sleep Regulations (PIN 20-24-CCP).

Incidental Medical Services (IMS) policy was discussed. Licensee states that she's not planning to provide IMS at this time.

Per review of the facility fire/disaster drill log, the last drill was conducted on July 14, 2021.

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



A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, 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: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 07/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2021
Section Cited

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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 mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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This requirement is not met as evidenced by: Per review of record, licensee's Mandated Reporter Training is expired. This poses a potential risk to the health and safety of children in care.
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Type B
09/10/2021
Section Cited

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Personnel Requirements: (c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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This requirement is not met as evidenced by: Licensee has expired First Aid certification. 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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3