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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700331
Report Date: 08/03/2023
Date Signed: 08/03/2023 01:14:04 PM

Document Has Been Signed on 08/03/2023 01:14 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:YOGASUNDRAM, SAJINIFACILITY NUMBER:
435700331
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 0DATE:
08/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sajini YogasundramTIME COMPLETED:
01:30 PM
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On 08/03/2023 at 11:30am Licensing Program Analysts (LPA) Christina Uribe and Randall Dunevant, met with licensee Sajini Yogasundram for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection is the licensee's fingerprint cleared and adult son. 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 facility is currently closed for the summer and will re-open on 08/10/2023.

The home is a single story home with 3 bedrooms, 3 bathrooms, living room, kitchen, dining area, detached garage and back yard. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort. The child care area is normally the second floor above the detached garage, however, the licensee is having the garage and the space above being renovated and is not being used. LPA Uribe approved the use of 2 rooms within the home to be used as a temporary child care space until the construction is completed. Licensee will inform LPA Uribe when the construction is complete in order for an inspection of the renovated space to be approved for day care use.

The OFF-LIMIT AREAS are the primary bedroom and bathroom, the first bedroom, the second bathroom, laundry room, kitchen, dining room and detached garage which are inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are the second bedroom and the first bathroom and backyard.

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 closed at all times while children are in the yard.

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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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: YOGASUNDRAM, SAJINI
FACILITY NUMBER: 435700331
VISIT DATE: 08/03/2023
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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 detector, telephone and fully stocked first aid kit. There are no pools, hot tubs or any other bodies of water present at the time of the inspection. Per licensee, there are no firearms on the premises and there are 2 dogs in the home.

The licensee completed the Health and Safety training, CPR/First Aid certification expires on 04/18/25. The licensee is in compliance with the immunization laws and has completed the mandated reporter training on 06/29/23. Licensee is reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 06/01/23. All required forms are posted and visible for public review.

Records: LPA Uribe reviewed 4 children’s files and personnel records. There is a current roster available for review. The facility does have liability insurance which is valid through 09/16/23. Staff interview also conducted and documented.



Provider Information Notices (PINs) & Quarterly 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 communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.

CCLD Inspection Process: 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.

MyChildCarePlan.org: 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.

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

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

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
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: YOGASUNDRAM, SAJINI
FACILITY NUMBER: 435700331
VISIT DATE: 08/03/2023
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Criminal Record Clearance: 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.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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/resources/child-care-centers/.

Megan’s Law: During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Unusual Incident/Student Injury Report: 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 found during today's inspection. One advisory note found during today's inspection:

  • Technical Violation: One child's Emergency Consent for Medical Treatment (LIC 627) form is filled out but it is the Children's Residential form (LIC 627B) not the required Family Child Care Homes form (LIC 627). Licensee will ensure that all forms used are the designated and correct LIC number.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. 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: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC809 (FAS) - (06/04)
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