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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422765
Report Date: 12/09/2021
Date Signed: 12/09/2021 11:16:36 AM

Document Has Been Signed on 12/09/2021 11:16 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:RAVEENDRA, SHANTHALAFACILITY NUMBER:
013422765
ADMINISTRATOR:RAVEENDRA, SHANTHALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 400-9582
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 10DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Shanthala Raveendra- LicenseeTIME COMPLETED:
11:30 AM
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On 12/9/21 at 9:49am, Licensing Program Analyst Briana Plumboy met with licensee Shanthala Raveendra for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was 1 infants, 9 preschool age children, and licensees husband/assistant Raveendra Narayanappa. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:30am until 6:00pm.

The home is 2 stories. The ON LIMITS areas are: the living room, dining area, downstairs bathroom, powder room, family room, bedroom #5/nap room, kitchen and backyard. The OFF LIMITS areas are: the entire second floor, bedroom #6, and the garage. The ISOLATION AREA will be the living room. There is a gate located between the living room and family room during today's inspection to prevent access to the stairs, as well as a gate located at the bottom of the stairs. The BACKYARD play area is fenced. There are toys. There are no pools, hot tubs or any other bodies of water present on the premises during today's inspection. There is a water fountain located in the backyard and filled with rocks. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during today's inspection.

The home has a fully charged 2A10BC fire extinguisher, smoke detector, carbon monoxide detector, and working telephone. The licensee CPR and First Aid certificate is current and expires 07/17/2023. The licensee's mandated reporter training is complete and licensee received a certification of completion on 05/14/2021. The licensee and assistant Raveendra Narayanappa are in compliance with the immunization law. The fireplace is barricaded to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 8/20/2021. 7 children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.
See 809-C and 809-D for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RAVEENDRA, SHANTHALA
FACILITY NUMBER: 013422765
VISIT DATE: 12/09/2021
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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

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Shanthala Raveendra 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 Shanthala Raveendra 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.

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

See 809-D for deficiency cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Shanthala Raveendra.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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Document Has Been Signed on 12/09/2021 11:16 AM - It Cannot Be Edited


Created By: Briana Plumboy On 12/09/2021 at 10:55 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: RAVEENDRA, SHANTHALA
FACILITY NUMBER: 013422765

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above due to the present assistant not having a current mandated reporter training certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/07/2022
Plan of Correction
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Training can be found at mandatedreporterca.com.
The licensee's assistant must complete the mandated reporter training by 01/07/22 and submit to LPA by email or mail.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Wynn Norona
LICENSING EVALUATOR NAME:Briana Plumboy
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2021


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