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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416220
Report Date: 10/07/2021
Date Signed: 10/07/2021 03:25:45 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:CHOPPALA, DEEVENAFACILITY NUMBER:
434416220
ADMINISTRATOR:DEEVENA CHOPPALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 216-8630
CITY:SAN JOSESTATE: CAZIP CODE:
95133
CAPACITY:14CENSUS: 8DATE:
10/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Deevena Choppala, LicenseeTIME COMPLETED:
03:40 PM
NARRATIVE
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#2 Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection at the day care home today and met with Licensee, Deevena Choppala. There are 4 people residing in the home: Licensee, her husband and their 2 adult children. However one of their children currently lives in the school campus. Review of records indicates that all individuals who require caregiver background checks have received criminal record clearance. Days and hours of operation are Monday thru Friday from 8:30AM to 5:00PM.

LPA toured the home inside and out with the Licensee. Off limit areas inside the home: . garage and all bedrooms and living room area. The home was observed to be clean and in good order. There are sufficient toys and play equipment for the day care children. Bathroom used by children was observed to be clean and in good condition. Per Licensee, there are no weapons and poisons in the home. Cleaning Products, toxic agents, medications, and sharp objects are inaccessible to children. The home has a fire extinguisher (2A10BC ), carbon monoxide and smoke detectors. The outdoor playground area is surrounded and enclosed by a fence. There are no bodies of water observed.

Staff records were reviewed which include fingerprint clearance, TB clearance, immunization (Measles, Pertussis, and Flu) record, and current CPR/First Aid and Mandated Reported Training Certifications. LPA discussed with Licensee Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is a required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Licensee's AB1207 Mandated Reporter Training certification expired in May 2020.

Continued on next page.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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: CHOPPALA, DEEVENA
FACILITY NUMBER: 434416220
VISIT DATE: 10/07/2021
NARRATIVE
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A review of staff records during today's inspection also indicates that her assistant, (Lakwinder Kaur) does not have immunization record for Measles, Pertussis, and Flu.

LPA obtained an updated copy of the roster of children in care. All 8 Children's records were reviewed which include Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice and Immunization record. LPA reminded Licensee that she must keep the Child Care Facility Roster current at all times and fire/disaster drills must be practiced at least once every 6 months and documented. LPA also reminded the Licensee that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding 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. Licensee stated that she will not administer any medication to day care children at this time.

LPA reminded the 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.



Care providers 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.

As a result of this inspection, deficiencies were cited. See LIC809D page for deficiencies. Exit interview conducted and copy of this report and appeals right form were discussed and provided to Licensee.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAY
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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: CHOPPALA, DEEVENA
FACILITY NUMBER: 434416220
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2021
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 was not met as evidenced by: Per review of record, the Licensee's AB1207 Mandated Reporter Training certificate expired in May 2020. This poses a potential risk to the health and safety of children in care.
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Type B
11/08/2021
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemptions: (a) (1) 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.
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This requirement is not met as evidenced by: Assistant does not have immunization against influenza, pertussis and measles. 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: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3