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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013421659
Report Date: 02/15/2024
Date Signed: 02/15/2024 11:39:24 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2023 and conducted by Evaluator Melanie Otsuji
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20231201111039
FACILITY NAME:MANI, JAYANTHIFACILITY NUMBER:
013421659
ADMINISTRATOR:MANI, JAYANTHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 737-2383
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:14CENSUS: 5DATE:
02/15/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jayanthi ManiTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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- Licensee is not home.
- Volunteers are supervising children without licensee.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conclude investigation into the above allegations. Present during today's visit was a fingerprint cleared assistant and 5 preschool aged children.

During the course of the investigation LPA conducted observations, record reviews and conducted interviews. During LPA's initial visit on, 12/17/2023, Licensee was not present. LPA conducted interviews and interviewees stated that Licensee was out of the country in the beginning of December. Based on LPAs observations and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety Code 1596.80 is being cited on the attached LIC. 9099D.

An exit interview and report reviewed with Licensee, Jayanthi Mani.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 52-CC-20231201111039
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/29/2024
Section Cited
CCR
102417(a)
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The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence.
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Licensee is to ensure she is present at the facility per regulation. Signed statement acknowledging the understanding of this regulation to be submitted to LPA no later than 2/29/2024 via email.
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 Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
-This requirement is not being met as evidence by: Licensee had to temporarily leave for three weeks due to family emergency.Which poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3