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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422924
Report Date: 12/13/2021
Date Signed: 12/13/2021 10:43:54 AM

Document Has Been Signed on 12/13/2021 10:43 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:CHINTA, LAKSHMIFACILITY NUMBER:
013422924
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lakshmi ChintaTIME COMPLETED:
10:50 AM
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On 12/13/2021 approximately at 9:00AM Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Lakshmi Chinta. Per licensee, she has not been providing care for about a year or so due to COVID. Also residing in the home is the licensee's fingerprinted and associated husband, Rajiv Puli along with their two young children (6, and 10). The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care will be Monday through Friday, 8:30am to 6:00pm.

ON LIMITS: living room, part of the backyard, bathroom nearest to the kitchen, and dining area, right side bedroom that will be used as an isolation area
OFF LIMITS: garage, bedroom # 1, bedroom #2, bedroom #3, left and right side of the yard, and all bathroom, kitchen. Off limit areas will be inaccessible by closed and/or locked doors, gates, and full supervision.
The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There is a fully charged 2A10BC fire extinguisher, working carbon monoxide and smoke detector, and working telephone. The home has a fireplace but will be blocked off by a secure gate Per licensee, there are no firearms or pets or any bodies of water in the home. Per licensee, she has store away all required licensing documents, but will post it up for public review once she starts having children in care. Licensee does not have any current children's files nor a current facility roster available for review. Licensee has proof of the required immunization. The licensee has not completed her updated mandated reporter training, but will send a copy of her certificate along with CPR and First Aid training was last completed on 8/20/2019; licensee will send a copy of renew of training once she begins to operate again via email or text.
See LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2021
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: CHINTA, LAKSHMI
FACILITY NUMBER: 013422924
VISIT DATE: 12/13/2021
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At 10:00am, the backyard was assessed. per licensee, she would have a colorful gate to block both sides of the yard to keep the children in the most visible area while they are outside. There were no sharp or pointy objects that can pose harmful to children during today's visit.

Exit interview conducted. Appeal rights and notice of site visit was given to licensee to post for 30 days.

No deficiencies were cited for today's inspection

Facility Representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

Facility Representative was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Facility Representative was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC809 (FAS) - (06/04)
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