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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701137
Report Date: 07/11/2024
Date Signed: 07/11/2024 11:37:19 AM

Document Has Been Signed on 07/11/2024 11:37 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:NARAYANAN, JAYALAKSHMIFACILITY NUMBER:
015701137
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/11/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Jayalakshmi Narayanan- ApplicantTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 7/11/24, Licensing Program Analyst Briana Plumboy, met with applicant Jayalakshmi Narayanan for an ANNOUNCED PRE LICENSING INSPECTION. Present for this visit was applicants fingerprint clear and associated husband Sankara Narayanan. The adults currently living in the home are applicant, her husband, son Nishok Tirunelveli, and daughter Nivethana Narayanan. The home was toured to conduct a Health and Safety Inspection. The applicant plans to operate the facility Monday through Friday, from 7:30am until 6:00pm.
The home is a two story home. On the first floor, there is a bedroom with bathroom located to the right of the entrance, dining room/ common area, hallway bathroom, office, kitchen, and living room. The second story consist of 3 bedrooms, a master bedroom with bathroom, laundry room, and hallway bathroom. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the entire second level of the home, living room, and kitchen which will be inaccessible by closed and/or locked doors and visual supervision. There are child safety gates in the home today located at the bottom of the stairs, at the entrance to the hallway bathroom, and at the entrances to the living room and kitchen. The ON LIMIT AREAS are the first bedroom with bathroom located on the right when entering the home, the office area located before the living room, the dining/ common area, and the hallway bathroom. The ISOLATION AREA will be the office. Outdoor play area will be in the fenced backyard, but not on the sides of the home. There are no swing sets or play structures present during today's inspection. There are toys and learning materials available that are safe and appeared to be clean. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection.
The home has a fully charged 3A40BC fire extinguisher, working combined smoke & carbon monoxide detector, and working telephone. The applicant’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 6/22/26. The applicant completed and received a certificate in mandated reporter training on 10/10/23. The applicant and her husband are in compliance with the immunization law which pertains to day care providers. The home has centralized heating and air conditioning. Per applicant, there are no firearms in the home. A copy of the mortgage statement was reviewed and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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: NARAYANAN, JAYALAKSHMI
FACILITY NUMBER: 015701137
VISIT DATE: 07/11/2024
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LPA discussed the safe sleep regulations with applicant Jayalakshmi Narayanan and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant 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.

Subscribe to CCLD important information - Child Care Centers and Family Child Care Homes: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The applicant Jayalakshmi Narayanan was reminded nothing shall hang over the infant cribs and not to swaddle infants while in care.

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

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



See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
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: NARAYANAN, JAYALAKSHMI
FACILITY NUMBER: 015701137
VISIT DATE: 07/11/2024
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The applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

California Law requires Family Child Care Home 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 by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

Applicant Jayalakshmi Narayanan is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.


During the exit interview, the applicant Jayalakshmi Narayanan confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

This home is recommended for licensing on 7/11/2424. The applicant is aware the signature on this report confirm receipt of these documents. LPA asked the applicant if the applicant had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the applicant, and per applicant, there are no further questions at this time. Applicant is aware at anytime she can reach out to LPA Plumboy or CCLD. This report shall remain on file for 3 years. Exit interview conducted applicant Jayalakshmi Narayanan.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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