<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422774
Report Date: 09/06/2024
Date Signed: 09/06/2024 03:35:41 PM

Document Has Been Signed on 09/06/2024 03:35 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:KUPPUSWAMY, HEMA MUTHULAKSHMIFACILITY NUMBER:
013422774
ADMINISTRATOR/
DIRECTOR:		KUPPUSWAMY, HEMA MUTHULAKSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(972) 979-5658
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Hema KuppuswamyTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On September 6, 2024 at approximately 12:35pm Licensing Program Analyst (LPA) Randy Miranda arrived unannounced for the purpose of conducting an annual inspection for health and safety. Present for today’s inspection was the licensee Hema Kuppuswamy and two fingerprint and TB cleared assistants and 8 children in care (2 two-years old; 4 three-years old; 2 four-years old). The hours of operation are Monday-Friday, 8:00am to 6:00pm.

The facility is a single-family home with 4 bedrooms and 2 bathrooms; a living room (day care area has a screened fireplace and also blocked); dining room; kitchen; attached 2-car garage; back and side yards. Access to the day care area is through the side gate and to the back sliding door. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

On-limit-areas include: The family room (day care area), dining room, hallway leading to the house bathroom, house bathroom at the end of the hall, back yard patio and grass area.



Off-limit-areas include: All four bedrooms, kitchen, master bathroom, attached 2-car garage, east side of backyard. All off limit areas are inaccessible by closed and/or locked doors, child gates and visual supervision.

There were ample age-appropriate toys that were observed to be safe and in good condition. The home and the day care area and rooms are neat and clean, with heating and ventilation for safety and comfort. Food and snacks are provided and found to be expired. LPA observed two one-gallon jugs of whole milk in the refrigerator - See LIC9102 for Technical Assistance.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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 4
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: KUPPUSWAMY, HEMA MUTHULAKSHMI
FACILITY NUMBER: 013422774
VISIT DATE: 09/06/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
There is a fully charged 2A10BC fire extinguisher located in the daycare room. The facility has a dual smoke and carbon monoxide detector, (tested and working). Per licensee, there are no firearms in the home. Last Fire/Disaster Drills occurred on July 2024. All licensing documents are posted and visible for public review.

Children's files were reviewed. The facility roster was reviewed, and a copy obtained. All files were complete and in good order.



The licensee’s Pediatric CPR/First Aid certificate is current and expires 5/20/2025. Mandated reporter training expires on 9/07/2026 (licensee); 7/27/2026 (assistant #1); 1/11/2026 (assistant #2). Assistants are in compliance with immunization law which pertains to day care providers.
LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Sleep logs and sleep checks for every 15 minutes. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

The licensee owns the property and does carry liability insurance (exp. 10/1/2024).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 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 Childcare 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.

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

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: KUPPUSWAMY, HEMA MUTHULAKSHMI
FACILITY NUMBER: 013422774
VISIT DATE: 09/06/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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

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.

There was one Technical Assistance issued during today’s inspection (Whole milk served to children in care). See LIC9102 for details.

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

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4