013419352-11-21-2024-52-CC-MOTI-DB8R73-20241121114541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419352
Report Date: 11/21/2024
Date Signed: 11/21/2024 11:45:56 AM

Document Has Been Signed on 11/21/2024 11:45 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, DHANALAKSHMI		FACILITY NUMBER:	013419352
ADMINISTRATOR/ DIRECTOR:	GOWTHAMAN, DHANALAKSHMI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 333-9685
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	11/21/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:12 AM
MET WITH:	Dhanalakshmi Gowthaman		TIME VISIT/ INSPECTION COMPLETED:	11:50 AM

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On November 21, 2024, Licensing Program Analyst (LPA) Melanie Otsuji arrived at the facility unannounced to conduct an Annual/Random Inspection. LPA met with Licensee, Dhanalakshmi Gowthaman. The facility is a two story single family home. Hours of operation for child care are Monday through Friday, 8:30am to 6pm. The following was observed during today’s inspection:

Capacity/Staffing: The facility operates as a Family Child Care Home (large), which may have a maximum capacity of twelve (12) to fourteen (14) children. At time of inspection, there were nine (9) children in care (6 preschoolers and 3 infants). The facility is in compliance with ratio and capacity limitations. There are two (2) fingerprint cleared assistants present during today's visit.

ON Limit areas (accessible to children in care): Living Room, Kitchen, Family Room, Day care Room, day care bathroom, and back yard. LPA observed the facility to be clean and in good repair, with heating and ventilation for safety and comfort. There are ample age appropriate toys that are observed to be safe and in good condition. The backyard has a fence surrounding the perimeter of the yard. There are no pools hot tubs or other bodies of water. LPA did not observe any dangerous conditions, nor any hazardous or toxic items accessible to children in the ON Limit areas of the facility today.

OFF Limit areas (not accessible to children in care): the entire second floor, laundry room, and garage. OFF Limit areas are inaccessible by closed and/or locked doors and visual supervision. Stairs are barricaded to prevent access to children under 5 years of age. Licensee is advised to contact Licensing so that an inspection can be completed prior to changing an OFF Limit area to ON Limit.

Emergency Preparedness/Safety: Facility has a fully charged fire extinguisher. Smoke and carbon monoxide detectors were tested and found to be functioning. First aid supplies are available. A fire/disaster drill was last conducted in June 2024 and meets the six month requirement. Facility has phone service. Per Licensee, there are no firearms in the home. Emergency Disaster Plan is current.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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: 11/21/2024

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Staff Records Review: Licensee and all adults living and/or working in the home have proper criminal background clearances. Licensee's mandated reporter training was taken on 8/4/2023 and is current. Assistants have also taken mandated reporter training and is current.. Licensee has current pediatric cpr/first aid training which expires in March 2026.

Children’s Records Review: All required licensing documents were observed. A facility roster is maintained.

Licensing Posting (required): Facility license, Notification of Parents’ Rights, Earthquake Preparedness.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 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.

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.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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: 11/21/2024

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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: 11/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC809 (FAS) - (06/04)

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