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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421659
Report Date: 04/21/2023
Date Signed: 04/21/2023 10:58:39 AM

Document Has Been Signed on 04/21/2023 10:58 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:MANI, JAYANTHIFACILITY NUMBER:
013421659
ADMINISTRATOR:MANI, JAYANTHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 737-2383
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
04/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jayanthi ManiTIME COMPLETED:
11:05 AM
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On 4/21/2023, Licensing Program Analyst (LPA) Melanie Otsuji, met with licensee Jayanthi Mani for an UNANNOUNCED 1 YEAR REQUIRED INSPECTION. At the time of LPA's arrival, Licensee's fingerprint cleared spouse and adult aged son were present however no children were present. Shortly after LPA's arrival 3 preschool aged children and a fingerprint cleared assistant arrived. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:45am until 6:00pm.

The ON LIMITS area consist of the living room, den, garage and hallway bathroom. OFF LIMITS areas consist of all bedrooms, kitchen and backyard. The off limits areas will be inaccessible by closed and/or locked doors and visual supervision. The home has heating and ventilation for safety and comfort. There are no pools, hot tubs or any other bodies of water present during today's inspection. The home has a fully charged 2A10BC fire extinguisher. Facility has a working smoke detector and working carbon monoxide detector, and working telephone. The licensee and her assistant are in compliance with the immunization law. Per licensee, there are no firearms in the home. All REQUIRED forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. 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: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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 2
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: MANI, JAYANTHI
FACILITY NUMBER: 013421659
VISIT DATE: 04/21/2023
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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.

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-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

No deficiencies noted on today's date. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Jayanthi Mani.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC809 (FAS) - (06/04)
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