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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700368
Report Date: 08/01/2022
Date Signed: 08/01/2022 12:02:25 PM

Document Has Been Signed on 08/01/2022 12:02 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:KAMATH, JAYALAKSHMIFACILITY NUMBER:
015700368
ADMINISTRATOR:KAMATH, JAYALAKSHMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 891-5619
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jayalakshmi KamathTIME COMPLETED:
12:15 PM
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On 08/01/2022, Licensing Program Analyst (LPA) Jaylena Miller met with applicant Jayalakshmi Kamath for an Announced Pre-Licensing Inspection. Present for the inspection was licensees fingerprint cleared and associated husband and infant son, licensee also has a school age son that lives in the home but was not present during the inspection. The applicant has applied for an initial Large Family Child Care Home License. The applicant plans to operate Monday-Friday from 8:30am-6:00pm and occasional weekends and overnight as needed by the parents. LPA conducted a health and safety inspection inside and outside with applicant.

The home is a two-story home with 4 bedrooms including the master bedroom and bathroom located on the first floor to the right of the home and all three additional bedroom located on the second floor, 3 bathrooms one on the second floor and two on the first floor that will be used for day care children, a living room, sun room, dining room, kitchen, family room, 2 car garage, and backyard which is completely fenced in. The garage can be accessed through the door to the left of the entrance. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort. The home has an electric fireplace which is located inside the living room and is screened to prevent access to children. There is a child safety gate located between the kitchen and family room and a door between the kitchen and the dining room during today’s inspection. There is a safety gate located at the base of the stairs which lead to the second story of the home, and the applicant is aware when children under the age of 5 years old are present in the home in care, the gate must be in place.

The OFF-LIMIT AREAS are the entire second floor and garage, and will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are the living room, sun room which will be used as the main day care area, the family room which will used as the nap room, kitchen, dining room, master bedroom and bathroom that is located to the right of the entrance. The designated isolation area will be the master bedroom and bathroom. The backyard will be a designated outdoor play area that is fully fenced. The outdoor area has age appropriate toys and furnishings that LPA observed to be clean and free from defects and dangerous conditions.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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 3
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: KAMATH, JAYALAKSHMI
FACILITY NUMBER: 015700368
VISIT DATE: 08/01/2022
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There is a gate to the right of the backyard that leads to a nearby park that applicant would like to use on occasion. LPA reminded applicant that 100% visual and physical supervision is required when children are walking to and from the park and while playing at the park. Applicant must also get permission from parents to walk to the park. There are no main roads between the home and the park but a clear cement sidewalk.

LPA observed the kitchen cabinets and drawers have child safety latches and knives are inaccessible to children. LPA did not observe any pools, hot tubes or any other bodies of water present at the facility during today’s inspection. All hazardous materials and toxins are kept out of reach from children and would not be accessible to children during care. The home has a fully charged 3A-40-BC fire extinguisher, working smoke detector, working carbon monoxide, telephone, and first aid kit. Per applicant, there are no firearms on the premises.

The applicant has received certificates of completion of Preventative Health and Safety training on 09/10/2017, the mandated reporter training on 01/27/2021, and CPR and First Aid which is current and expires on 03/19/2024. LPA Miller discussed with applicant the CPR/First Aid and Mandated Reporter Training must be renewed every two years and CPR/First Aid needs to be EMSA approved. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. The applicant has proof of the provider immunizations on file.

Applicant was reminded that all adults 18 and over living or working 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed 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.

LPA reviewed with applicant the LIC 311D, Forms/Records to keep in your Family Child Care Home, Children’s forms/records, facility forms/records, and information to be posted.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
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: KAMATH, JAYALAKSHMI
FACILITY NUMBER: 015700368
VISIT DATE: 08/01/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed families, 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.

Fire clearance was granted on 7/18/2022 and home is recommended for licensing as of 08/1/2022. Exit interview conducted with Applicant and report was reviewed with the applicant Jayalakshmi Kamath.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
LIC809 (FAS) - (06/04)
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