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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417022
Report Date: 02/08/2022
Date Signed: 02/08/2022 03:23:03 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:VIDYARAMBHFACILITY NUMBER:
434417022
ADMINISTRATOR:AJANTA DASFACILITY TYPE:
830
ADDRESS:2931 EL CAMINO REALTELEPHONE:
(408) 758-8192
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:30CENSUS: 0DATE:
02/08/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Sujatha NamboodiriTIME COMPLETED:
03:25 PM
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Licensing Program Manager (LPM) Mary Segura and Licensing Program Analyst (LPA) Dung Mac conducted a scheduled informal office meeting at the San Jose Regional Office with Sujatha Namboodiri, LLC Manager. The purpose of today's meeting was to discuss the following issues: director qualifications and several documents required for the Infant application. Current Site Director, Ajanta Das, is not qualified for Site Director at this time.

LPM discussed the documents that need to be updated and submitted, included but not limited to LIC 200A, LIC 309, LIC 401, LIC 500, LIC 610, in order for the application to be complete. Sujatha was provided copies of the application review and documents that need to be updated. Sujatha will be submitting a copy of Director Permit for Ajanta Das or copies of a different Site Director who is fully qualified for Site Director. Sujatha agreed to submit all updated documents to LPA Mac by March 8, 2022.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022
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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