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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700233
Report Date: 07/21/2021
Date Signed: 07/21/2021 12:17:49 PM

Document Has Been Signed on 07/21/2021 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:NAYAK, USHAFACILITY NUMBER:
075700233
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/21/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Usha NayakTIME COMPLETED:
12:30 PM
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On July 20, 2021, at 9:30am, Licensing Program Analyst (LPA) Julia Placencia arrived announced for a Prelicensing Inspection, and met with the applicant Usha Nayak and her husband Sadashiva Nayak. Also residing in the home is the applicant’s son Snehith Nayak. All adults have proper fingerprint clearances. The home was toured with the applicant and her husband to conduct a health and safety inspection. Per applicant, the hours of operation for day care will be Monday through Friday, 8:00am to 6:00pm.

The home is single story, which consists of a kitchen, dining room, family room, living room, four bedrooms, two bathrooms, garage and a backyard. The home is neat and clean with heating and ventilation for safety and comfort.

ON LIMITS: Daycare room (first bedroom to the left in hallway), master bedroom/bathroom, living room, family room, dining room, kitchen, left side yard. The isolation area will be the living room.

OFF LIMITS: Office, son's bedroom, garage, rear and right side yards. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits.

The outdoor play area will be the left side yard, which is gated from the rest of yard, and free from defects or dangerous conditions. There are ample age appropriate toys, inside and outside, which are observed to be safe, clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPA did not observe any hazardous materials or toxins accessible to children today. Knives will be stored in a locked kitchen drawer to the left of stove. The home has a working smoke detector/carbon monoxide combination unit on the ceiling in the living room, a telephone and first aid kit. The fireplace is screened, and per applicant, is never used. Heater vents are located on the ceiling. Per applicant, there are no firearms in the home.
***Continued on LIC 809C...
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
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 3
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: NAYAK, USHA
FACILITY NUMBER: 075700233
VISIT DATE: 07/21/2021
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The applicant’s health and safety training has been completed, and includes the child nutrition and lead poisoning prevention components. Applicant’s First Aid/CPR certificate is current, expiring on 7/17/2023. Documentation has been reviewed that shows control of property. The applicant has provided proof of the required immunizations for daycare providers, and mandated reporter training was completed on 6/12/2021. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed, and copies were left with the applicant. Safe Sleep regulations were discussed, and new car seat laws were provided. Applicant was reminded that children are never to be left in a parked vehicle.

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.

The applicant was 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 encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Applicant submitted COVID-19 Self-Assessment Guide. LPA reviewed responses with applicant and provided technical assistance including postings.

***Continued on LIC 809C...
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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: NAYAK, USHA
FACILITY NUMBER: 075700233
VISIT DATE: 07/21/2021
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The following corrections are required before the home can be licensed:
  • Install a child proof lock in the kitchen drawer where knives and other sharp items will be stored.
  • Purchase a size 2A10BC or higher fire extinguisher.

These corrections shall be submitted by providing pictures within 10 days of this report. LPA may visit facility to confirm corrections have been complete.

Exit interview conducted with Usha Nayak, and copy of report provided.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3