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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422765
Report Date: 01/24/2023
Date Signed: 01/24/2023 03:09:52 PM

Document Has Been Signed on 01/24/2023 03:09 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
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: 14CENSUS: 11DATE:
01/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Shanthala Raveendra- LicenseeTIME COMPLETED:
03:20 PM
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On 1/24/23 at 2:17pm, Licensing Program Analyst Briana Plumboy met with licensee Shanthala Raveendra for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was 4 infants, 7 preschool age children, fingerprint clear and associated assistant Pinderjit Kaur, 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, bedroom #6, kitchen and backyard. The OFF LIMITS areas are: the entire second floor 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 and Pinderjit Kaur's 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, Raveendra Narayanappa, and Pinderjit Kaur 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 9/22/22. 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 for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RAVEENDRA, SHANTHALA
FACILITY NUMBER: 013422765
VISIT DATE: 01/24/2023
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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.

No deficiencies 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: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
LIC809 (FAS) - (06/04)
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