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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625804
Report Date: 03/02/2022
Date Signed: 03/02/2022 12:00:07 PM

Document Has Been Signed on 03/02/2022 12:00 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:PANNEERSELVAM, MATHIVADHANI FAMILY CHILD CAREFACILITY NUMBER:
376625804
ADMINISTRATOR:MATHIVADHANI P.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 736-6915
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
03/02/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Mathivadhani PanneerselvamTIME COMPLETED:
12:05 PM
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On 3/2/2022 at 11:05am, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced plan of correction inspection to ensure that the facility is within compliance with Title 22 regulations.

All citations issued on 2/16/2022 have been cleared including the following:
  • Analyst observed children two and older are wearing mask during inside activities.
  • Bathroom sink cabinet is latched to prevent children access to hazardous items
  • Licensee and helpers have completed the online mandated child abuse training
  • Safe sleep log are being use for infants during nap time


Children's files have the LIC9224 acknowledgement of receipt of licensing report in their files regarding the type A citation issued.

Facility is within substantial compliance during today's inspection. Notice of Site was provided during today's inspection and it shall be remain posted for 30 days.


Licensee shall submit an Incidental Medical Service (IMS) Plan to Analyst within 30 days as one of the child in care needs IMS service.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2022
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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