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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419352
Report Date: 07/19/2023
Date Signed: 07/19/2023 11:32:20 AM

Document Has Been Signed on 07/19/2023 11:32 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:
07/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Dhanalakshmi GowthamanTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced on today's date, 07/19/2023, to conduct a Required - 1 Year inspection. LPA was met by Licensee Dhanalakshmi Gowthaman. Also present during today's visit were 2 fingerprint cleared assistants, Licensee's adult aged sister and 7 children (3 infants, 4 preschoolers). LPA conducted a health and safety inspection inside and outside. Facility's current hours of operation are: Monday through 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 May 2023.

Storage areas for poisons are inaccessible. Detergents and other cleaning compounds that can pose a danger to children are stored where inaccessible. The home is kept clean, and orderly with ventilation for safety and comfort. LPA observed safe toys, play equipment and materials. The home has a working telephone on site. Outdoor play areas are fenced and supervision is provided while children are outside. On today's date, Licensee was within the proper capacity for their large family child care home license. All individuals present during today's date had the proper criminal record clearance. Each child's file contained the appropriate documentation.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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: 07/19/2023
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, Dhanalakshmi Gowthaman, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days. No citations found on today's date.
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: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
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