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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700331
Report Date: 07/29/2022
Date Signed: 07/29/2022 11:24:42 AM

Document Has Been Signed on 07/29/2022 11:24 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:YOGASUNDRAM, SAJINIFACILITY NUMBER:
435700331
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
07/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sajini YogasundramTIME COMPLETED:
11:45 AM
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On 07/29/2022 at 9:00am Licensing Program Analyst (LPA) Christina Uribe, met with licensee Sajini Yogasundram for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection were 3 daycare children, 1 fingerprint cleared assistant, and 2 fingerprint cleared adult residents of home, and the licensee is within ratio today. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday-Friday 8:30am-4:00pm.

The home is a single story home with a detached garage and back yard. The home is entirely off limits to children in care as well as the garage. The on limit area is the main day care section which is located in the Additional Dwelling Unit (ADU) which is located above the garage. Access to the ADU is with an outdoor staircase which has a safety gate located at the top of the landing and safety rope for children to hold onto leading up the steps and a railing. The ADU consists of a full bathroom, kitchen, living room, and bedroom. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort.

The facility’s outdoor play space is located in the backyard of the home. The play structure, equipment, and fence are all in safe condition free from hazards which could pose a risk to children in care. There is ample shade available and gates are locked at all times while children are in the yard. There are no pools, hot tubs or any other bodies of water present at the time of the inspection. There is a small water fountain in the back yard however, it is non-functional and licensee does not have plans to use it.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, carbon monoxide, telephone and fully stocked first aid kit.. Per licensee, there are no firearms on the premises in the home and all pets are kept inside of the main house which is off limits to children.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2022
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 4
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: YOGASUNDRAM, SAJINI
FACILITY NUMBER: 435700331
VISIT DATE: 07/29/2022
NARRATIVE
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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 05/05/2023 The licensee is in compliance with the immunization laws and has completed the mandated reporter training on 04/08/2021. The assistant also has current certifications and immunization requirements met.

The licensee conducts and documents fire and disaster drills at least twice a year and the last conducted drill was on 06/01/22. All required forms are posted and visible for public review.

LPA Uribe reviewed 5 children’s files and personnel records. Licensee does not provide care to infants and therefore is in compliance with safe sleep regulations. There is a current roster available for review. The facility does have liability insurance which is valid through 01/05/23. Staff interview also conducted and documented.

Incidental Medical Services (IMS) policy was discussed and LPA reviewed medication, storage, and records for compliance. 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.

Plans to Renovate: Licensee stated that she is in the process of possibly converting the garage into the new day care space to eliminate the need for stairs and to have direct access to the backyard for easier transitions. Additionally, during the construction phase, licensee plans on converting one of the bedrooms in her home into a temporary day care space. LPA informed the licensee that prior to moving into the temporary space she needs to notify LPA, create a new Facility Sketch (LIC 999) which shows the new on limit areas of the home (bedroom and bathroom), and to not utilize it until LPA Uribe has conducted an inspection and approved the space to be used. LPA Uribe also explained the same process for when the construction is finished and she is ready to move into the permanent day care space in the converted garage.

Criminal Record Clearance for Licensee's Daughter: The licensee's 17-year-old daughter will be turning 18 years old in November 2022. LPA Uribe reminded the licensee that her daughter needs to be fingerprint cleared soon and discussed the process for a Live Scan.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: YOGASUNDRAM, SAJINI
FACILITY NUMBER: 435700331
VISIT DATE: 07/29/2022
NARRATIVE
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

No deficiencies cited during today's inspection. Please see attached advisory note page for information on technical violation issued today.

  • Technical Violation: Some of the children's files have the wrong Consent for Emergency Medical Treatment form filled out. The correct form is the LIC 627 form specific to Child Care Centers or Family Child Care Homes.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Sajini Yogasundram.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC809 (FAS) - (06/04)
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