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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417022
Report Date: 03/21/2022
Date Signed: 03/21/2022 10:50:13 AM


Document Has Been Signed on 03/21/2022 10:50 AM - It Cannot Be Edited

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: DATE:
03/21/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Sujantha NamboodiriTIME COMPLETED:
11:00 AM
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On 03/21/2022 at 10:15 AM, Licensing Program Manager (LPM) and Licensing Program Analyst (LPA) Mary Segura and Susy Cervantes, met with applicant, Sujatha Namboodiri, in regards to the incomplete application for an infant child care center, this is the second office visit for an incomplete application.

LPM reviewed with applicant the missing/incomplete documents as well as items that need to be corrected on the application. LPM provided applicant an updated list of revision that need to be made and discussed, but is not limited to: LIC 200, LIC 610, LIC 309, LIC 401, Needs and services, immunizations, termination conditions, attendance review, job descriptions, parent handbook, IMS (PIN 22-02 provided to applicant), admission agreement, mandated abuse reporting procedure, menus, bedding. LIC 501 and SB792 verifications for Director Ajanta Das.

Prelicensing inspection will be conducted after corrections are completed.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy CervantesTELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2022
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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