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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409266
Report Date: 11/22/2023
Date Signed: 11/22/2023 11:50:37 AM

Document Has Been Signed on 11/22/2023 11:50 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
OAKLAND CC RO, 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:
11/22/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sai Lakshmi MaddalaTIME COMPLETED:
12:00 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 11/22/23 at 9:00 am, Licensing Program Analyst (LPA) Sikia Blue arrived at the home for an announced Required Random Inspection and Change of Capacity. LPA met with Sai Lakshmi Maddala to explain the purpose of today’s visit. Present in the home was licensee and husband. Today census is 0 with eight children enrolled. The facility operating hours are Monday-Friday 8:00am-5:00pm. Licensee provides meals for all children in care but two, the parents provide food for those two children.

LPA toured the areas of the home used to provide care for children, to complete a health and safety inspection. The home is neat and clean with heating and ventilation for the safety and comfort of children in care. This is a two story 3 bedrooms and 2 and a half bathroom home which consists of the living room, dining room, kitchen, fenced backyard for outdoor play area, three bedrooms, 2 ½ bathrooms, and garage. The living room, dining room, downstairs bathroom are the ON LIMIT areas. The OFF LIMIT areas are the 2nd floor 3 bedrooms, 2 bathrooms, kitchen and garage. These areas are inaccessible to children in care by closed and/or locked doors, visual supervision and a safety gate at the bottom of the stairs. The ISOLATION area will be a section of the dining room, away from other children in care. The backyard is used for outdoor play and LPA observed that all the toys were neat and clean and equipment safe for children to play. The parent board is located behind the door on the bookshelf for parents to see and has all the required documents at this time.

Continued on 809-C

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Sikia Blue
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2023
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 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MADDALA, SAI LAKSHMI
FACILITY NUMBER: 073409266
VISIT DATE: 11/22/2023
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
LPA observed an ample supply of age appropriate toys, equipment and furniture that appear to be safe and in good condition. LPA DID NOT observe any bodies of water. LPA DID NOT observe any hazardous materials, toxins or medications accessible to children today. The home is equipped with a smoke detector, carbon monoxide detector, working telephone, and fully stocked first aid kit. The fire extinguisher is a 3A-40-BC fully charged in the green area. The licensee's CPR/First Aid certificates are current, with an expiration date of 9/25. The licensee completed the required mandated reporter training, and it will expire on 5/08/24. The licensee stated that there are no firearms in the home. LPA observed pull alarm and emergency exit sign posted by the back door.

At 9:35 applicant asked licensee if fire/earthquake drill have been conducted and the form filled out licensee stated they have not conducted the required fire and safety drill and the form is not complete. Licensee had the forms and LPA explained how to conduct fire and safety drills and best practice to keep the log on the parent board as a reminder to conduct the drills and complete the form. Licensee confirmed that the emergency disaster plan is up to date. LPA reviewed 5 children’s files and found them to be complete with all required documents.

At 10:00 LPA Reviewed two personnel files and one was incomplete missing employee rights and employee important information (address, phone number), and no employee application or proof of employment. LPA explained best practice to keep necessary important information in personnel file for all employees. The licensee was reminded that walkers, baby bouncers and drop down cribs are not allowed in day care facilities. LPA observed the Facility roaster and it has all children and is complete. LPA also observed the provider has a sleep plan for the 15 month old infant. The provider was informed of the importance of continuously making sure the sleep plan is filled out properly and accurately. LPA explained the importance of the roaster being current and up to date at all times for the facility records and needs to be kept for 3 years.

Continued on 809 - C

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Sikia Blue
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MADDALA, SAI LAKSHMI
FACILITY NUMBER: 073409266
VISIT DATE: 11/22/2023
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
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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.

LPA discussed the safe sleep regulations with licensee 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 [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.

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/.

Continued on 809 - C

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Sikia Blue
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
LIC809 (FAS) - (06/04)
Page: 7 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MADDALA, SAI LAKSHMI
FACILITY NUMBER: 073409266
VISIT DATE: 11/22/2023
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
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.

Exit interview conducted at 11:45 am, change of capacity approved the Licensee confirmed that there are no Registered Sex Offenders living in the facility, and an RSO check and profile was completed by Licensing. Notice of site visit was given and must remain posted for 30 days. Report was reviewed and given to the licensee, Sai Lakshmi Maddala. Appeal rights were provided.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Sikia Blue
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
LIC809 (FAS) - (06/04)
Page: 8 of 8