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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419352
Report Date: 03/21/2023
Date Signed: 03/21/2023 11:29:29 AM

Document Has Been Signed on 03/21/2023 11:29 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GOWTHAMAN, DHANALAKSHMIFACILITY NUMBER:
013419352
ADMINISTRATOR:GOWTHAMAN, DHANALAKSHMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 333-9685
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
03/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Dhanalakshmi GowthamanTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct a REQUIRED 1 YEAR INSPECTION. LPA was met by Licensee, Dhanalakshmi Gowthaman. LPA toured the day care for a health & safety check. Also present were 2 fingerprint cleared assistants and 7 children (2 infants and 5 preschoolers). Hours of Operation is: Monday - Friday 8:00AM-6:00PM.

The interior and exterior of the home was toured. The home is a two story single family home. The ON LIMITS areas are: Living Room, Kitchen, Family Room, Day care Room, day care bathroom, and back yard. The OFF LIMITS areas are: the entire second floor, laundry room, and garage. The stairs are barricaded when children under 5 are in care. LPA observed a fully charged fire extinguisher, working carbon monoxide and smoke detector on site. Licensee has current Pediatric CPR/First Aid and it expires on 3/3/2024. Licensee conducts and documents disaster drills. The last drill conducted was in January 2023.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GOWTHAMAN, DHANALAKSHMI
FACILITY NUMBER: 013419352
VISIT DATE: 03/21/2023
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies noted on today's date. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Dhanalakshmi Gowthaman.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC809 (FAS) - (06/04)
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