<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416532
Report Date: 12/13/2022
Date Signed: 12/13/2022 07:17:40 PM

Document Has Been Signed on 12/13/2022 07:17 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BEJJALA, NAGAJAYALAKSHMIFACILITY NUMBER:
434416532
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Bejjala Nagajayala TIME COMPLETED:
11:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 PAGE 1
Licensing Program Analyst (LPA’s) Stephanie Collins conducted an announced, scheduled Pre-Licensing inspection of 3428 Golf Drive San Jose CA. 95127 San Jose. LPA met with Applicant NAGAJAYALAKSHMI BEJJALA . Applicant is applying for a license to operate a Small Family Child Care Home with a maximum capacity of eight at the address listed above.

A copy of the control of property is on file. LPA observed that the home has a fully charged . Smoke and Carbon Monoxide Detectors were tested and proved to be functioning. The home’s disaster plan of action was discussed along with the requirement for the home to conduct and document fire and disaster drills at least once every six months. LPA reminded Applicant that smoking is not allowed in Family Child Care Homes and baby walkers cannot be used for children in care and need to be kept inaccessible.

Days and hours of operation will be Monday through Friday 8:00 AM to 6:00 PM. Applicant has completed 16 hours of training on preventive health practices with Lead, which included pediatric cardiopulmonary resuscitation and pediatric first aid, and one hour on Child Care Nutrition. Applicant's Pediatric and CPR certification expires 5/12/23. Applicant has documented proof of immunity against Measles and Pertussis. Applicant's Certification of Completion of the AB1207 Mandated Reporter Training expires 9/22/2024.


Adults who are over the age of 18 and reside in the home are the Applicant the Applicant's Spouse (Pavankumar Bijjla. ) adult daughter Somya Bijjala and son Hemanth Bijjala


SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BEJJALA, NAGAJAYALAKSHMI
FACILITY NUMBER: 434416532
VISIT DATE: 12/13/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
PAGE 2
All have Clearances for Criminal Record and Child Abuse Index Background Check, and Tuberculosis.
LPA reminded Applicant about the applicable civil penalties for those adults who have not received fingerprint clearances, who are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

LPA inspected the indoor and outdoor areas of the home. Off limits areas in the home are Bedroom 1, and kitchen area garage . The home has an enclosed patio area the entrance is off the master bedroom. The patio will be used for supervised outdoor activity. The rest of the backyard is off limits. Applicant Nagajayala Bejjala is aware that she has to be with the children at all times.

The home is clean and orderly, with heating and ventilation for safety and comfort of children in care. Fireplaces and open-face heaters were observed to be screened to prevent access by children. The home contain a fire extinguisher and smoke detector device. Applicant stated that there are no weapons such as firearm stored on the premises. The home does not have any pets. Detergents, cleaning compounds, sharps, medicines, and other items which could pose a danger if readily available to children were stored where they are inaccessible, out of reach of children. LPA reminded Applicant that poisons need to be locked.

Applicant stated that the form of discipline to be used are talking and redirecting the children. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Applicants stated that she understands that the children have personal rights that cannot be waived or abridged regardless of consent or authorization from the child’s authorized representative.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BEJJALA, NAGAJAYALAKSHMI
FACILITY NUMBER: 434416532
VISIT DATE: 12/13/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Page 3

LPA went over the records that need to be maintained at the home with Applicant.

Applicant is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of Laws, etc.

LPA also discussed with the Applicant about the continuing requirements, which include but are not limited to the following topics: (1) Separating sick children when they show signs of illness; (2) Supervision of Children; (3) Capacity Options; (4) transportation of children; (5) Procedures for Reporting Suspected Child Abuse and Unusual Incidents/Injuries; LPA reviewed with applicant LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA discussed the safe sleep regulations with applicant/Gwendolyn and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BEJJALA, NAGAJAYALAKSHMI
FACILITY NUMBER: 434416532
VISIT DATE: 12/13/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 4
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Exit interview conducted and report was reviewed with the Applicant Nagajayala Bejjala .

Based on today's inspection, Once the following item is corrected and submitted for review to Community Care Office, The Applicant's file will be submitted to Licensing Management for final review and approval.

1: Fire extinguisher (2A and above (3A-40B:C)
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4