015700441-3-28-2023-52-CC-AWRT-CQBREX-20230327125816

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700441
Report Date: 03/27/2023
Date Signed: 03/28/2023 11:19:04 AM

Document Has Been Signed on 03/28/2023 11:19 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	PURUSHOTHAMAN, DIVYA		FACILITY NUMBER:	015700441
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	03/27/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Divya Purushothaman		TIME COMPLETED:	01:05 PM

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On March 27th 2023 at 10:00am, Licensing Program Analyst (LPA) April Wright met with applicant Divya Purushothaman for an announced pre-licensing visit to conduct a health and safety inspection. Present during today's inspection was the applicants’ fingerprint and cleared spouse Nirmal Rishi Varadarajan. Also residing in the home, but not present at time of inspection are the applicants two sons, ages 10 years and 5 years old. Hours of operation will be Monday to Friday, 7:00am to 6:30pm.

The applicants’ home is a two story home is neat and orderly with heating and ventilation to provide safety and comfort . Home consists of three bedrooms, two bathrooms, Living/Dining room and patio/backyard. The home has a fully charged 2A10BC fire extinguisher and have five (5) functioning carbon monoxide/smoke detectors. LPA reviewed the deed provided by the applicant that shows soul ownership of the property.

On Limits: The areas of the day care will consist of Living/Dining Room (Daycare rooms), Downstairs bedroom (napping Room), patio/backyard and downstairs bathroom(across from napping room).

Off Limits: Entire second level of the home, garage, kitchen with a child safety gate to prevent access to those areas.

The patio area was observed and is free from defects or dangerous conditions. There are age appropriate toys for the children to utilize. There are no pools, hot tubs, or any other bodies of water on the premises. Per licensee, there are no pets or firearms present at the home. All hazardous materials and toxins are out of the reach of children by installing child safety locks on the cabinets and drawers.

Applicant's Preventive Health and Safety training was completed on 10/9/2022 and CPR/First Aid certificates are current and will expire on 11/12/2024. Applicant completed the Mandated Reporter training on 1/23/2023 and the applicants are following immunization law as it pertains to all day-care providers. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. LPA Wright discussed the Safe Sleep practices with applicant.

See LIC809C for continuance

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PURUSHOTHAMAN, DIVYA	FACILITY NUMBER: 015700441
	VISIT DATE: 03/27/2023

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LPA Wright reminded the applicant of the following: Mandated Reporter training is to be renewed every two years; CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports.

The applicant is also reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

LPA Wright provided a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Individual Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

This home is recommended for licensure. This report shall remain on file for 3 years. Exit interview conducted and appeal rights were given to Applicant Divya Purushothaman.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC809 (FAS) - (06/04)

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