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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622645
Report Date: 02/06/2024
Date Signed: 02/06/2024 11:12:55 AM

Document Has Been Signed on 02/06/2024 11:12 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:KUKKUNURU, KAVITHAFACILITY NUMBER:
393622645
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
02/06/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Kavitha KukkunuruTIME COMPLETED:
11:25 AM
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On February 6,2024, Licensing Program Analyst (LPA) Stacey Williams met with Licensee, Kavitha Kukkunuru for the purpose of conducting a plan of correction inspection. LPA observed (8) eight children in care supervised by the Licensee and her assistant.

LPA discussed the plan of correction that was issued on 1/31/2024. Licensee stated that she reviewed Title 22 regulations with staff and has a clear understanding of ratio/capacity requirements for family childcare homes. LPA reviewed signed LIC 9224 copies in child files and safe sleep log created by Licensee.

LPA reviewed report with Kavitha Kukkunuru and provided copies of the report and plan of correction letter 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: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2024
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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