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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701057
Report Date: 12/16/2024
Date Signed: 12/16/2024 12:19:37 PM

Document Has Been Signed on 12/16/2024 12:19 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:KODURU, DEEPTHIFACILITY NUMBER:
015701057
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
12/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Deepthi Koduru TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On December 16, 2024, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux arrived unannounced for an UNANNOUNCED ANNUAL INSPECTION . Present during today's inspection was licensee, Deepthi Koduru and fingerprint cleared husband and 4 children in care (along with the licensee minor child). Also residing in the home is the licensee two children (5 year old son and 12 old daughter). The home was toured with the licensee to conduct a health and safety inspection. Hours of operation are Monday - Friday, 8:00 am to 5:30pm.

The home is a two story single family home 3 bedroom and 2.5 bathrooms with an attached two car garage. The home is neat and clean with heating and ventilation for safety and comfort. Licensee confirmed that she resides in the home. Licensee states she does not provide transportation.

ON LIMITS: Living room, family room, kitchen and half bathroom and rear yard. The rear yard is fully fenced. There are no pools/hot tubs during today's inspection. Licensee confirmed there are no pools/bodies of water at the home. The isolation area will be in the living room in the front of the home away from the children in care. Inspection of the rear yard could not be completed due to the current weather conditions.

OFF LIMITS: Entire Second Floor, three bedrooms (including master bedroom and bathroom), bathroom, and the loft area. The 2 car garage on the main level. Rear yard, right side there is a safety gate to keep the children out of the area, and on the left side small section off limits, during todays inspection there is a safety gate. There is shed in the off limits with a lock. All Off Limit areas will be inaccessible by closed and/or locked doors, safety gates and visual supervision.

***Continued on LIC 809C...
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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: KODURU, DEEPTHI
FACILITY NUMBER: 015701057
VISIT DATE: 12/16/2024
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All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 2A40BC fire extinguisher, working smoke detector, carbon monoxide detector (both tested and functioning), telephone and fully stocked first aid kit. Per licensee, there are no firearms on the premises or pets in the home.

The licensee completed the Health and Safety training, CPR/First Aid certification expires on 02/4/2025. The licensee is in compliance with the immunization laws and has completed the mandated reporter training. Licensee is reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 06/10/24. All required forms are posted and visible for public review.

Records: At 11:00 AM, LPA reviewed three (3) children’s files and personnel records for licensee and assistants present. There is a current roster available for review and copy obtained.



CCLD Inspection Process: To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
Criminal Record Clearance: 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.


Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: KODURU, DEEPTHI
FACILITY NUMBER: 015701057
VISIT DATE: 12/16/2024
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Safe Sleep: 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): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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/resources/child-care-centers/.

MyChildCarePlan.org: 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.

Megan’s Law: During the exit interview, the licensee, Deepthi Koduru confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

No deficiencies noted, there are three (3) Advisory Notes issued during today's inspection:

· Advisory Note (TV): Emergency Drills are performed regularly but are not recorded as required.


· Advisory Note (TV): Mandated Reporter Training Expired for licensee and Staff/Volunteer need MR updated for Child Care Providers.
· Advisory Note (TV): One staff (volunteer) member needs to obtain an updated immunization record (MMR).

A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee, Deepthi Koduru.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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