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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625804
Report Date: 02/25/2025
Date Signed: 02/25/2025 11:01:57 AM

Document Has Been Signed on 02/25/2025 11:01 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:PANNEERSELVAM, MATHIVADHANI FAMILY CHILD CAREFACILITY NUMBER:
376625804
ADMINISTRATOR/
DIRECTOR:		MATHIVADHANI P.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 736-6915
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
02/25/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Panneerselvam, MathivadhaniTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 2/25/25 at 8:45 AM Licensing Program Analyst (LPA) Adriana Macias conducted an unannounced annual inspection. Upon arrival, LPA identified herself and provided badge to Licensee Mathivadhani Panneerselvam. The two story, single family home was toured and inspected to ensure an environment safe for the care and supervision of children. There were 8 children in care. Also present was helper Nadia Lozano. Licensee stated she has 8 children enrolled, and her hours of operation are from 7:30 am to 5:30 pm.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include the Living Room, Family Room, Kitchen, Restroom 1, and Room 1, all located on the first floor. Off limits areas include Room 2, Room 3, Room 4, Master Bedroom, Restroom 2, and Restroom 3 , all located on the second floor, and are inaccessible through use of gated stairs. There is a fully fenced backyard used for outdoor playtime. The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home. Licensee states that there are no weapons in the home.

Licensee’s First Aid and CPR certifications expire on 1/18/27 and helper’s First Aid and CPR certifications expire on 3/16/26. Licensee and helper have required immunizations. Licensee’s Mandated Reported Training Certificates expires on 2/18/27. The helpers Mandated Reporter Certification expires on 2/13/26. Licensee’s and helper’s immunization requirements were met as well as for other adults living at home. All adults living or working in the home, have received criminal record and child abuse clearances or exemptions.


Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. (CONT ON LIC809C)
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Adriana Macias
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PANNEERSELVAM, MATHIVADHANI FAMILY CHILD CARE
FACILITY NUMBER: 376625804
VISIT DATE: 02/25/2025
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LPA reviewed with Licensee the LIC 311D, Forms/Records. To Keep In Your Family Childcare Homes, children’s forms/records, facility forms/records, and information to be posted.
LPA discussed and provided Licensee with the following: childcare advocates-email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Childcare Licensing Duty Line at (619) 767-2248.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
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.

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 [or facility representative] 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) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

(CON ON LIC809C)

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Adriana Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PANNEERSELVAM, MATHIVADHANI FAMILY CHILD CARE
FACILITY NUMBER: 376625804
VISIT DATE: 02/25/2025
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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.
During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA observed no deficiencies.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Mathivadhani Panneerselvam. Appeal Right were also printed and issued to licensee.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Adriana Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
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