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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409266
Report Date: 06/02/2022
Date Signed: 06/07/2022 09:31:37 AM

Document Has Been Signed on 06/07/2022 09:31 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MADDALA, SAI LAKSHMIFACILITY NUMBER:
073409266
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:SAI LAKSHMI MADDALATIME COMPLETED:
12:30 PM
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9:00- Licensing Program Analyst Tasha Alexander met today with Sai Lakshmi Maddala for an ANNOUNCED PRE-LICENSING INSPECTION. Applicant, her husband, adult daughter, and adult son are the present for the inspection. The home is a two story house consisting of 3 bedrooms, 2.5 bathrooms, loft, living room, kitchen, laundry room, garage and backyard. The living room, downstairs bathroom and backyard will be used as the primary areas for day care. The off limits areas will be the entire upstairs which consists of the 3rd bedrooms, 2 bathrooms, loft and laundry room. These areas will be inaccessible to children in care by closed and/or locked doors , visual supervision and a safety gate at the bottom of the stairs. Applicant and her husband Visweswara rao Maddala owns the home; proof was shown. Per applicant there are no firearms/weapons located on the premises. There is a 2A10BC fire extinguisher in the home. The smoke alarm/ carbon monoxide combo was tested today and are found to be in working condition; recommended periodic servicing. There are no swimming pools, hot tubs or other bodies of water located on the premises. All sharp knives, cleaning solutions and medications are inaccessible to children in care. First aid kit is available and complete. The isolation area for sick children will be in the dinning area of the living room. Outdoor play will be in the backyard which is completely fenced. There are toys and play space available. Applicants were instructed to conduct and document periodic fire and disaster drills. Applicants were informed that baby walkers, exersaucers and baby bouncers are not allowed. Applicants have completed CPR and first aid training which expires in 9/1/2023 respectively. Applicants have completed 16 hours of health and safety training which included the 1 hour of Nutrition and 1 hour of Lead poisoning training.

Mandated reporter and appeal rights were discussed. Licensing forms were reviewed and copies given to applicant. Applicant was instructed on the law establishing a $100 fine per day for adults who are living in the home or who are providing care who do not have fingerprint clearances. Applicant was also instructed on the law requiring notification to parents regarding exclusions.
All forms can be downloaded at www.ccld.ca.gov. www.myccl.gov for day-care updates.
CONTINUED ON 809-C`
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MADDALA, SAI LAKSHMI
FACILITY NUMBER: 073409266
VISIT DATE: 06/02/2022
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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

DURING TODAY'S PRE-LICENSING INSPECTION THE RESOURCE MATERIALS FOR COVID-19 WERE ALSO DISCUSSED TO HELP THE FACILITY STAY SAFE DURING THIS PANDEMIC.

As a result of today's visit, the following needs to be corrected before a license can be issued:



1. The rose bushes located in the backyard need to be made inaccesible to children by fencing them or removing them.

2. The A/C unit located in the backyard needs to be made inaccessible to chilren in care by covering the top where the fan is.


An exit interview was conducted
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022
LIC809 (FAS) - (06/04)
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