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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416142
Report Date: 07/21/2021
Date Signed: 07/22/2021 08:27:36 AM

Document Has Been Signed on 07/22/2021 08:27 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:VIDYARAMBHFACILITY NUMBER:
434416142
ADMINISTRATOR:SUJATHA NAMBOODIRIFACILITY TYPE:
850
ADDRESS:2931 EL CAMINO REALTELEPHONE:
(408) 758-8192
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 165TOTAL ENROLLED CHILDREN: 142CENSUS: 80DATE:
07/21/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ajanta DasTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Anna Morales met with Assistant Director Ajanta Das , for an unannounced Case Management - Incident Inspection. The purpose of the inspection was related to an Unusual Incident Report, UIR, that was self reported by Director Sujatha Namboodiri on 7/20/2021. This incident involved C1 whom sustained an injury to after bumping into a pole on the playground on 7/16/2021, approximately at 11:42am.

On 7/16/2021, there were 17 children and two teachers present. Eight of the 17 children were playing on another location of the playground( soccer area) and the remaining children where playing in the "bike area". Also, In this area, there is a basketball hoop/pole and a blue pole with a "basket like" with three holes on the top for the children to throw balls. C1 was with with the group of children who were playing on the "bike area" where the injury was obtained as C1 bumped into the blue pole.

On 7/21/2021, LPA Morales inspected the playground. LPA did not observe any screws, holes or other sharp objects. LPA,also reviewed a recording copy of the incident. LPA interviewed staff, including C1 teachers who were present at the time of the incident. LPA also reviewed the sign in and sign out sheet and obtained a copy.

A deficiency is not being cited based on the LPAs observations, interviews conducted, and record reviews in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, with the Assistant Director.

NOTICE OF SITE VISIT WILL BE ISSUED. ASSISTANT DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

Due to technical difficulties, LPA was unable to leave copy of this report. LPA will submit a copy to the Center once she returns to the office.


SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
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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