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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700220
Report Date: 07/23/2021
Date Signed: 07/23/2021 02:36:47 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/23/2021 02:36 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PADAKANDLA TIRUMALA, INDIRARAYALFACILITY NUMBER:
075700220
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Indirarayal Tirumala PadakandlaTIME COMPLETED:
02:35 PM
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On 7/23/2021 at 1:45pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Indirarayal Tirumala Padakandla for an announced annual inspection and capacity change. Present during the inspection was the Licensee. There were no children present during the inspection. Licensee lives in the home with her husband Lakshmi Panala and her 9-year-old daughter. The Licensee’s home was toured for a health and safety inspection. The operating hours are 8:00am – 6:00pm Monday – Friday.

ON LIMITS AREA: Living Room, Family Room, Downstairs Bathroom, and Backyard


OFF LIMITS AREA: Entire 2nd Floor and Garage and Kitchen
ISOLATION AREA: Living Room

Licensee obtained fire clearance on 7/13/2021 from the San Ramon Valley Fire Protection Department.

The facility is a two story home owned by the Licensee. The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there no firearms and no pets in the facility. Fireplace in the family room is blacked off and made inaccessible to children.

The home has one (1) fully charged 3A40BC fire extinguisher in the kitchen. There is a pull-down fire alarm in the kitchen as well. There is one (1) working smoke detector in the hallway and the family room. There is a working carbon monoxide detector in the living room. The home is equipped with central heat and air for proper ventilation.

Cont on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2021
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PADAKANDLA TIRUMALA, INDIRARAYAL
FACILITY NUMBER: 075700220
VISIT DATE: 07/23/2021
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At 2:15pm LPA obtained the facility roster and three (3) children’s files. All files are complete. The Licensee’s Health and Safety training has been completed and CPR and First Aid training is complete with an expiration date of 7/19/2022. Licensee’s fire and disaster drill log is complete with the last drill logged 3/09/2021. Licensee’s Mandated Reporter training is valid and expires on 2/6/2022. All required forms are posted and visible for public view on the living room.

Licensee was reminded that California Law requires 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 email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.



Licensee is reminded that ALL Licensees, 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 $3,000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter.

All fire/disaster drill must be conducted every six months and documented. The Licensee is reminded that any structural changes to the facility or additions to the childcare facility must be reported to Community Care Licensing.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Licensee for a signature. There are no deficiencies being cited today. This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
LIC809 (FAS) - (06/04)
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