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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700382
Report Date: 06/23/2023
Date Signed: 06/23/2023 03:51:30 PM

Document Has Been Signed on 06/23/2023 03:51 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MUPPALLA, NAVYAFACILITY NUMBER:
435700382
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/23/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Navya MuppallaTIME COMPLETED:
04:15 PM
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On Friday, June 23, 2023, at 1:45 PM, Licensing Program Analysts (LPAs) Manel Estoesta and Jaleesa Jackson conducted an announced Pre-licensing Visit. LPA met with the Applicant Navya Muppalla and explained the nature of site visit. Present on this visit was the Applicant's Spouse Naveen Varma.

The applicant submitted a Family Child Care Home (FCCH) Small License Application and received in the Regional Office on 05/10/2023. The home plans to operate from Monday to Friday 8:30am to 5:30pm.

LPA toured the home to conduct a Health and Safety Inspection with the Applicant. The home is a one-story home. The home is neat and clean with central heating and ventilation for safety and comfort.

The On-Limit Areas are the Living Room, Bedroom adjacent to the Living Room will be used for napping, hallway bathroom and backyard. The backyard will be a designated outdoor play area that is fully fenced. The Bedroom adjacent to the Living Room will be used for napping are the designated Isolation Area when a child gets sick.

The home does have a fully charged 2A10BC fire extinguisher, last serviced in 2001 and LPA Estoesta advised the applicant to have it service and or buy a new one. Applicant understood. The home has a working smoke detector and carbon monoxide and working mobile phone.

The Off Limit Area are the Kitchen, Master Bedroom with master bathroom, the Bedroom number 2 (Office room) adjacent to the Bedroom (napping room) and side yards. No garage in the home. LPA discussed to the applicant that the Off Limit Areas will be inaccessible to children by locked doors, safety gates and visual supervision.

SEE 809 C.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MUPPALLA, NAVYA
FACILITY NUMBER: 435700382
VISIT DATE: 06/23/2023
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Continuation...

The applicant is renting the property and LPA reviewed the applicants lease agreement with the licensee.

The applicants completed the Health and Safety training completed on 04/15/2023, and CPR (Pediatric) and First Aid completed in April 2023 with validity period of 2 years. The applicants completed the AB1207 Child Care Providers training online on 04/14/2023 at https://mandatedreporterca.com/. LPA reminded the applicant that AB1207 requires 2-year renewal. The applicant has records of Measles and Pertussis immunization, Influenza declination statement and TB clearance. LPA reminded the applicant that only the Influenza vaccination can be decline with a written declination.

LPA provided technical assistance during inspection with the following.


1. Review of all required forms and information to be kept on file (Children’s forms/Records, Facility forms/Records, Information to be posted) 2. Reporting and Notifications Requirements 3. General Information (Child Care Updates, Provider Information Notification, etc.) 4. Miscellaneous Resources (Resources and Referral Agencies, Child Care Law Center, etc.) 4. Family Child Care Home Licensing Laws and Regulations 5. Child Care Advocate and Technical Support Program.

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

LPA discussed the safe sleep regulations with the applicant 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 the applicant 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. SEE 809 C.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MUPPALLA, NAVYA
FACILITY NUMBER: 435700382
VISIT DATE: 06/23/2023
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Continuation...
At 2:15 pm, during the home tour inspection with the applicant, LPA Estoesta observed 2 storages in the backyard without a padlock, the garage converted to a room that has a separate access from the side yard is occupied by another renter. LPA Estoesta advised to place a padlock on the storage and have the other renter to be fingerprinted. The applicant understood.

LPA discussed to the applicant about the Resources for Providers CDSS Programs Community Care Licensing Child Care Program Website and Child Care Resource and Referral Agencies R&Rs, Guardian website and Inspection Authority of the Department.

Resources for Providers https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers

Watch these brief, informative videos to learn more about putting Licensing regulations and requirements into practice - https://ccld.childcarevideos.org/family-child-care-providers/



Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

The home is not yet recommended for a FCCH license due to the missing requirements mentioned above. Applicant will complete the missing requirements and will submit it to the LPAs.

Exit interview conducted and report was reviewed with the applicant, Navya Muppalla.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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