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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700441
Report Date: 07/10/2024
Date Signed: 07/10/2024 01:26:07 PM

Document Has Been Signed on 07/10/2024 01:26 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, DIVYAFACILITY NUMBER:
015700441
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
07/10/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Divya PurushothamanTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On July 10th, 2024 at approximately 12:15pm, Licensing Program Analyst (LPA) April Wright met with licensee Divya Purushothaman for the purpose of an Increase in Capacity Inspection. Present during the inspection were four children (2 infant/2 preschool age) and Licensee fingerprint cleared spouse. The home was toured for health and safety inspection. Hours of operation are 7:00am to 6:30pm Monday through Friday.

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). The patio is fully fenced and is free of defects, hazards and damage.

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. LPA advised and Licensee confirmed of their responsibility to ensure that children never eat or sleep in the garage.

The two story home consists of three bedrooms, two bathrooms, Living/Dining room 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 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. LPA observed and Licensee confirmed that there are no pools, hot tubs or any bodies of water present in the home. LPA observed and Licensee confirmed that there are no hazardous materials, including cleaning products, medicines or toxins visibly present or accessible to children in care during the inspection. The home has a fully charged 2A10BC fire extinguisher and five (5) smoke/carbon monoxide detectors. Licensee confirmed that there are no pets, weapons or firearms present in the home. LPA advised and Licensee understands their responsibilities and to inform CCLD if any firearms are purchased or brought into 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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 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.

Capacity Increase: All requested/required documents were received for the increase in capacity application and verified by the LPA on 5/22/2024. The fire clearance for a capacity of fourteen (14) was approved by the Fremont Fire Department and received by CCLD via fax on 7/1/2024. The Licensee is reminded to abide by the conditions of the fire clearance which states that day care is not permitted in the garage. Pull down fire alarm is located in Day care room #1 (Living Room area) on the right side of the wall near the couch. The licensee was reminded that an assistant must be present at ALL times when there is more than eight (8) children in attendance. Whenever the assistant is not present, the licensee will comply with the capacity requirements for a small family child care home . A copy of Capacity Requirements for a Family Child Care Homes (small and large) were reviewed and given to licensee. Licensee understands that capacity requirements for family child care homes.

Assistant Requirements: LPA discussed with licensee the requirements and documents required for an assistant to be working and present with children in care. LPA advised licensee to have completed and received all documents prior to the assistants first day of employment in the family child care home. When the licensee has an assistant, the licensee will ensure that the assistant has the following documents and placed in a personnel file for review: 1) Mandated Reporter certificate for Child Care Providers (AB1207), 2) Criminal Record Clearance and associated to the facility (Guardian), 3) Proof of immunization against Measles (MMR) & Pertussis (Tdap), 4) Proof of TB Clearance, & 5) Signed copy of the Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) Form. CPR & First Aide is required if the assistant is left alone with the children.

The home is recommended for an increase of capacity of up to 14 children as of 7/10/2024.

A notice of site visit of given was given and must be posted for 30 days. Exit interview was 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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