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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621011
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:11:04 PM

Document Has Been Signed on 03/07/2023 03:11 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
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: 18DATE:
03/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Himabindu NagabhiravaTIME COMPLETED:
03:20 PM
NARRATIVE
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On March 7, 2023 Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of conducting a plan of correction inspection. LPA was met by Assistant, Himabindu Nagabhirava. . LPA observed (18) eighteen children supervised by two Assistants.

LPA was informed that Licensee was away from the facility for a medical appointment. LPA requested to review staff files, however was unable to do so based on Assistants not having complete access to staff files.

Based on LPA's observation of eighteen children in the facility, the Licensee is operating out of staffing ratio and capacity of her license. Title 22 deficiencies will be cited on subsequent page, LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, acknowledging receipt of Licensing Reports LIC 809D in each child's files



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: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
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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Document Has Been Signed on 03/07/2023 03:11 PM - It Cannot Be Edited


Created By: Stacey Williams On 03/07/2023 at 02:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: KAIRAMKONDA, SARITHA
FACILITY NUMBER: 393621011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2023
Section Cited
CCR
102416.5(a)(d)

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Staffing Ratio and Capacity:
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time
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LPA provided Assistant with regulations that cover staffing Ratio and Capacity. Assistant will give Licensee the LIC 809, 809D report to review. Licensee shall submit to CCL confirmation that Regulations concerning ratio and capacity was reviewed and will ensure that ratio is met at all time regardless of Licensee being present in the home.
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(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10.
This requirement was not met as evidenced by: The Licensee was not present in the facility during the inspection. LPA was informed the Licensee was at a medical appointment. LPA observed (18) eighteen children supervised by two Assistants. This poses an immediate risk to the health and safety of children in care.
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Submission confirming review and understanding of the regulations is due by plan of correction date.- 3/8/2023

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bettina Engelman
LICENSING EVALUATOR NAME:Stacey Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
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