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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621011
Report Date: 03/27/2024
Date Signed: 03/27/2024 10:22:39 AM

Document Has Been Signed on 03/27/2024 10:22 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KAIRAMKONDA, SARITHAFACILITY NUMBER:
393621011
ADMINISTRATOR:KAIRAMKONDA, SARITHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 281-2133
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
03/27/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Himabindu Nagabhirava TIME COMPLETED:
10:30 AM
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On March 27, 2024, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative,Himabindu Nagabhirava for the purpose of conducting a plan of correction inspection. LPA observed eight children in care being supervised by two staff.

LPA discussed the plan of correction (POC) that was issued. LPA reviewed staff files during today's inspection. Plan of correction cleared and POC letter was given to the Facility Representative.

LPA reviewed report with Himabindu Nagabhirava and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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