015700441-7-10-2024-52-CC-AWRT-D72QMC-20240710121718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700441
Report Date: 07/10/2024
Date Signed: 07/10/2024 12:17:26 PM

Document Has Been Signed on 07/10/2024 12:17 PM - 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/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 4	DATE:	07/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Divya Purushothaman		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

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On July 10th, 2024 at approximately 10:30am, Licensing Program Analyst (LPA) April Wright arrived for an Annual/Random Inspection and met with licensee Divya Purushothaman. Present during today's inspection were four (4) children (2 infants/2 preschool age) and the licensees fingerprint and cleared spouse. The home was toured for a health and safety inspection. Hours of operation will be Monday to Friday, 7:00am to 6:30pm.

The two story home consists of three bedrooms, two bathrooms, Living/Dining room, garage and patio. The home is neat and orderly with heating and ventilation for safety and comfort of children in care. There are age appropriate toys and furniture for the children to utilize. The isolation area for sick children is a section of the living room on the couch which is away from children in care.

On Limits: The areas of the day care will consist of Living Room (Daycare area #1), Dining Room area (Daycare area #2), Downstairs bedroom (napping Room to left of daycare area #1), patio and downstairs bathroom(across from napping room).

Off Limits: The entire second level of the home which includes remaining two bedrooms and bathroom, garage and kitchen. Child safety gates are in place to prevent access to these areas of the home. Licensee was reminded that children shall not sleep nor play in the garage.

The home has a fully charged 2A10BC fire extinguisher and five (5) functioning carbon monoxide/smoke detectors. LPA observed and Licensee confirmed that are no toxins, medicines, cleaning products or hazardous materials visible during the inspection and were made inaccessible to children in care. Child safety locks have been installed on all cabinets and drawers to prevent access. The patio area is fenced and LPA observed there were no defects, hazards or dangerous conditions. LPA observed and Licensee confirmed that there are no pools, hot tubs, or any other bodies of water on the premises. Licensee confirmed that there are no pets, weapons or firearms present at the home.

See LIC809C for continuance

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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

FACILITY NAME: PURUSHOTHAMAN, DIVYA	FACILITY NUMBER: 015700441
	VISIT DATE: 07/10/2024

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All individuals subject to criminal record review have a clearance or exemption and have been associated to the this FCCH. LPA requested and reviewed the files of four (4) children in care. The children's files contained all required forms including Parents rights, medical consent forms and identification/emergency contact forms. The children's roster was reviewed and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 4/17/2024. The licensee has current Mandated reporter training which was completed on 1/23/2023 and CPR/First aid certificate which expires on 11/12/2024. The licensee is in ratio today. All required forms are posted and visible for public review upon entry to the home.

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 athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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/.

See LIC809C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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

FACILITY NAME: PURUSHOTHAMAN, DIVYA	FACILITY NUMBER: 015700441
	VISIT DATE: 07/10/2024

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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, Licensee Divya 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. Exit interview conducted and report was reviewed with the licensee Divya Purushothaman.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC809 (FAS) - (06/04)

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