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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415075
Report Date: 08/21/2019
Date Signed: 08/21/2019 04:39:05 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:MURUGESAN, SHANMUGAM & SHANMUGAM, VENNILAFACILITY NUMBER:
434415075
ADMINISTRATOR:SHANMUGAM & VENNILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 982-5971
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:14CENSUS: 15DATE:
08/21/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Thejashri AnandanTIME COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analysts (LPA) Shannel Reed conducted an unannounced required 3 year inspection to the home today. LPA met with Licensee’s Assistants, Thejashri Anandan, Dhwani Goyal and Rajalakshmi Harihar, and explained the nature of today's visit. At the time of arrival, the Assistants had 15 preschool children. The Ms. Harihar contacted the Licensee, who was off site with his spouse Vennila for their sons school enrollment/ orientation in Atlanta, Gerogia. LPA explained to the Assistants and Mr. Shan (via telephone) the Staffing Ratio and Capacity regulations. The Assistants and Mr. Shan stated that a few of the children will be picked up by 2:30 PM. LPA observed that three children did leave the home by 2PM.
Days and hours of operation are Monday – Friday from 8:00AM- 7:30PM. The Ms. Goyal stated that the Licensees, Shanmugam and Vennila are the only adults that live in the home. Licensee’s and all three Assistants have current and valid CPR/ First Aid certifications.

LPA toured the indoor and outdoor areas of the home during today's visit. LPA observed the required posted documentation. LPA obtained and observed a Child Care Facility Roster. The last Fire Drill was conducted in April 2019. The day care has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children stored in the garage, which Ms. Goyal and Ms. Harihar stated are brought inside when for the children to play with then packed and stored in the garage. Off limit areas inside the home: all three bedrooms and the garage. Off limit areas outside the home: the entire backyard.
LPA observed a fully charged 2A10BC fire extinguisher. LPA observed operational smoke and carbon monoxide detectors. LPA did not observed fireplace in the home. Ms. Anandan stated that there are no firearms or other weapons in the home. Detergents, cleaning compounds are inaccessible to children on an upper shelf in the hall cabinet or in the garage.

REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 08/21/19):
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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: MURUGESAN, SHANMUGAM & SHANMUGAM, VENNILA
FACILITY NUMBER: 434415075
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2019
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement is not met as evidenced by: LPA observed the Licensee’s three Assistants present with 15 preschool aged children in care. This is an immediate risk to the
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Three (3) children were picked up during this inspection. The Licensees shall provide LPA a written statement detailing a plan to ensure that the facility will maintain compliance with the Staffing Ratio and Capacity regulation by the POC Due date of 08/22/19.
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 children in care.
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Per AB633- Parent Notification is required.

LIC 9224 provided.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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: MURUGESAN, SHANMUGAM & SHANMUGAM, VENNILA
FACILITY NUMBER: 434415075
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2019
Section Cited
HSC
1596.8662(b)
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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.
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The Licensees and their Assistants shall complete the Mandated Reporter training (AB1207) and the Licensee shall submit a copy of the certificates of completion to LPA by the POC due date of October 04, 2019.
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This requirement is not met as evidenced by: LPA did not observed certificates of completion of the required Mandated Reporter training (AB1207) for the Licensees and their Assistants as of August 21, 2019. This is a potential risk to the children in care and a deficiency to the Health and Safety regulations.
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Type B
09/20/2019
Section Cited
HSC
1597.622(a)(1)
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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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as
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The Licensees will submit proof of immunity against Pertussis, Measles and influenza for themselves and their Assistants to LPA by the POC due date of September 20, 2019.
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evidenced by: LPA observed that the Licensee does not have the required immunizations against Pertussis, Measles and influenza for themselves and their Assistants on file as of August 21, 2019. This poses a potential health and safety risk to children in care and is a deficiency to the Health and Safety regulations.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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: MURUGESAN, SHANMUGAM & SHANMUGAM, VENNILA
FACILITY NUMBER: 434415075
VISIT DATE: 08/21/2019
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/21/19):
A review of Staff records indicates that all persons that require a caregiver background check have received criminal record and child abuse index clearance or exemption. LPA informed the Licensees and Assistants of the applicable civil penalties for any adult who has not received fingerprint clearances, is not associated to the license and who comes in contact with or provides 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.

LPA reviewed 11 children’s files. Seven of the children’s files are missing the Parents Rights form (LIC995) and Immunization's. Four (4) children, who started in the program on Monday, 08/19/19, do not have files at all.

LPA reviewed the Licensees and staff files. LPA did not observed certificates of completion of the required Mandated Reporter training (AB1207) for the Licensees and their Assistants. LPA did not observe the required immunizations against Pertussis, Measles and an Influenza (or decline statement) on file for the Licensees and their Assistants. Supervision of children was discussed with Ms. Anandan. Ms. Anandan stated that they nor the Licensees transport children via vehicle, but they understand that children cannot be left in parked vehicles unattended at any time.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensees can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov.
The Mandated Reporter Training (AB1207) can be completed at the website listed. http://www.mandatedreporterca.com. LPA discussed with and provided Lead Safety Information (AB2370) to Ms. Harihar

Title 22 deficiencies were cited on the subsequent pages of this report.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 2 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: MURUGESAN, SHANMUGAM & SHANMUGAM, VENNILA
FACILITY NUMBER: 434415075
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2019
Section Cited
CCR
102418(g)
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Immunizations. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled. This requirement is not met as evidenced by: LPA observed that are missing the required immunization documentation on file for six (6) children enrolled as of August 21, 2019. This is a potential risk too the children in care.
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Licensee shall obtain immunization record for each child that is enrolled in the program and maintain these records while the child is in care. Licensee will submit a copy of the missing immunization records to LPA by the POC due date of September 20, 2019.
Type B
09/20/2019
Section Cited
CCR
102419(d)
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Admission Procedures and Parental and Authorized Representative's Rights
At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A. This requirement is not met as evidenced by:
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Licensee shall obtain the signed Acknowledgement of Notification of Parents’ Right form for each child that is enrolled in the program and maintain these records while the child is in care. Licensee will submit a copy of the missing Acknowledgement of Notification of Parents’ Right form to LPA by the POC due date of September 20, 2019.
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LPA observed at least seven (7) children’s files are missing the Acknowledgement of Notification of Parents’ Rights.
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Type B
09/20/2019
Section Cited
CCR
102421(b)
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Child's Records The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7). This requirement is not met as evidenced by: LPA observed at least four (4) children’s files are missing the Identification and Emergency Contact form (LIC700).
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Licensee shall obtain the completed and signed required documentation for each child that is enrolled in the program and maintain these records while the child is in care. Licensee will submit a copy of the missing file information to LPA by the POC due date of September 20, 2019.
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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5