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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422736
Report Date: 10/10/2024
Date Signed: 10/10/2024 04:07:14 PM

Document Has Been Signed on 10/10/2024 04:07 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LAKSHMANAN, LAKSHMI PRABHAFACILITY NUMBER:
013422736
ADMINISTRATOR/
DIRECTOR:		LAKSHMANAN, LAKSHMI PRAHBHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 592-1617
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 5DATE:
10/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:09 PM
MET WITH:Lakshmi Prabha LakshmananTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On October 10, 2024 at approximately 1:09pm Licensing Program Analyst (LPA) Randy Miranda arrived for an unannounced visit to conduct an annual inspection for health and safety. Living in the home is the licensee, her TB test and fingerprint cleared husband, TB test and fingerprint cleared adult son (age 18), and one adolescent son (age 16). Present for today’s inspection was licensee Lakshmi Prabha Lakshmanan, licensee’s assistant, and 5 children (1 three-years-old; 2 two-years-old; and 2 one-year-old) in care. The hours of operation are Monday-Friday, 8:00am to 6:00pm.

The facility is a single-story home with 4 bedrooms, 2 bathrooms, a kitchen, dining room, living room, attached 2-car garage, front, side and back yards. There is a friendly German Shepherd family pet with a license and up to date vaccinations. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Per the licensee, the ISOLATION AREA will be in the on-limits bedroom on the right side of the hall, away from the other children in care. The licensee owns the property and carries liability insurance through Acord DCI, policy expires 11/26/2024. All required licensing documents are posted and visible for public review.



On-limit-areas include: The living room, bedroom on the right side of the living room (day care area), main house bathroom, and bedroom next to main house bathroom, and the patio in the back yard surrounded by child fencing.
Off-limit-areas include: The master bedroom and attached bathroom at the end of the hall, the second bedroom on the left side of the hall near the front of the house, kitchen, dining room, the attached 2-car garage the side yard of the house (contains a locked shed) and side yard on the east side of the home. All off-limit areas are inaccessible by closed and/or locked doors, child gates and visual supervision.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LAKSHMANAN, LAKSHMI PRABHA
FACILITY NUMBER: 013422736
VISIT DATE: 10/10/2024
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There is a fully charged 2A10BC fire extinguisher, mounted on the dining room wall, a working (tested) carbon monoxide and smoke detectors. Per licensee, there are no firearms in the home. Fire/Disaster Drills were conducted and documented on 09/12/2024.

Children's files were reviewed and found to be complete and in good order, however a children’s file was missing LIC995A. The facility roster was reviewed, and a copy taken for the office file.



The outdoor play area in the back yard is very large with a tennis court and child fencing to keep the children out of the side yard that has a locked shed. There were ample age-appropriate toys that were observed to be safe and in good condition. In the day care room there is a free standing fireplace with a child gate surrounding it. The day care rooms are neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials, bodies of water, or toxins accessible to children on the premises during the inspection.

The licensee and helper's Pediatric CPR/First Aid certificate is current and expires 8/20/2025. Mandated Reporter certificate for licensee and helper expires on 8/24/2025. LPA reminded the licensee of the following: Mandated Reporter certificate and CPR/First Aid certificate must be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. Licensee, her assistant, and all adults living in the home are in compliance with immunization law which pertains to day care providers.

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.



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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LAKSHMANAN, LAKSHMI PRABHA
FACILITY NUMBER: 013422736
VISIT DATE: 10/10/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/.

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.

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 inspectionprocess@dss.ca.gov. 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.

No deficiencies were issued during today’s visit.



A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided.

Exit interview conducted and report was reviewed with the licensee Lakshmi Prabha Lakshmanan .
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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