015700197-2-6-2024-52-CC-BPLY-D27TMP-20240206135128

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700197
Report Date: 02/06/2024
Date Signed: 02/06/2024 01:51:34 PM

Document Has Been Signed on 02/06/2024 01:51 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	SHIVASUBRAMANI, UMADEVI		FACILITY NUMBER:	015700197
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 2	CENSUS: 3	DATE:	02/06/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Umadevi Shivasubramani- Licensee		TIME COMPLETED:	02:00 PM

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	On 2/6/24, Licensing Program Analyst Briana Plumboy, met with licensee Umadevi Shivasubramani for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was licensees fingerprint clear and associated husband Pandiarajan Subramani, 1 infant, 1 preschool age child, licensees school age child, and fingerprint clear and associated assistant Mahboobha Ahmadi. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:45am until 5:30pm. The home is a single story home. The home consists of 2 bedrooms, a master bedroom with a master bathroom, a hallway bathroom, dining room, a living room, a kitchen, and garage. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the master bedroom with master bathroom, first bedroom on the right side of the hallway, the bedroom located at the end of the hallway on the right, the kitchen, and the garage which will be inaccessible by closed and/or locked doors and visual supervision. There are child safety gates located on both entrances to the kitchen. The ON LIMIT AREAS are the living room, dining room, the hallway bathroom, and the backyard. There is a shed located in the backyard which is off limits to children in care. The ISOLATION AREA will be the dining room area. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 12/3/24, and assistant Mahboobha received her CPR/First Aid certificate on 3/31/23. The licensee completed and received a certificate in mandated reporter training on 08/23/22, and assistant Mahboobha received her mandated reporter training certificate on 5/10/23. The licensee and assistant are in compliance with new immunization law which pertains to day care providers. There are no wall heaters or fireplaces in the home during today's inspection. The home has centralized heating. Per licensee, there are no firearms in the See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SHIVASUBRAMANI, UMADEVI	FACILITY NUMBER: 015700197
	VISIT DATE: 02/06/2024

NARRATIVE

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home. The licensee has documented her last disaster drill was conducted on 5/22/23, the facility was closed from July 30, 2023 until January 21, 2024, and reopened the childcare on January 22, 2024. Licensee informed LPA Plumboy of the closure prior to temporary closing. All REQUIRED forms are posted and visible for public review. Licensee is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

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 platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Family Child Care Homes Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SHIVASUBRAMANI, UMADEVI	FACILITY NUMBER: 015700197
	VISIT DATE: 02/06/2024

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA discussed the safe sleep regulations with licensee Umadevi Shivasubramani and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed licensee Umadevi Shivasubramani 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.

During the exit interview, the Licensee Umadevi Shivasubramani confirmed that there are no Registered Sex Offenders living in the facility.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Umadevi Shivasubramani.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024

LIC809 (FAS) - (06/04)

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