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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500705
Report Date: 12/04/2024
Date Signed: 12/04/2024 10:34:49 AM

Document Has Been Signed on 12/04/2024 10:34 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:AKULA, LAXMIFACILITY NUMBER:
394500705
ADMINISTRATOR/
DIRECTOR:		AKULA, LAXMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 223-7860
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
12/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Laxmi AkulaTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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On December 4, 2024, Licensing Program Analyst (LPA) Stacey Williams met with Licensee, Laxmi Akula for the purpose of conducting a case management inspection. LPA observed Licensee and her Assistant supervising eleven children.

LPA and Licensee discussed the plan of correction issued on October 29, 2024 regarding facility records. LPA reviewed records during today's inspection. The Plan of Correction will be cleared. Plan of correction letter was provided to Licensee.

An Exit interview was conducted, and the report was reviewed with Licensee, Laxmi Akula. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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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