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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422924
Report Date: 12/07/2022
Date Signed: 12/07/2022 10:53:11 AM

Document Has Been Signed on 12/07/2022 10:53 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: 0CENSUS: 0DATE:
12/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Lakshmi Chinta TIME COMPLETED:
11:00 AM
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On 12/07/2022 approximately at 10:27AM Licensing Program Analyst (LPA) Kelly Phan arrived for an unannounced case management visit to change facility status from inactive to active, and met with Licensee Lakshmi Chinta. There were no children present today. Also residing in the home is the licensee's fingerprinted and associated husband and their two children (11 and 7). The home was toured with the licensee to conduct a health and safety inspection.

At 10:40AM, LPA observed that there is now a working carbon monoxide installed at the facility. As of today, 12/07/2022 the facility is now active and can start accepting children in her care. Licensee states that she may resume her day care sometime in January or February 2023. LPA reminded licensee to continue to update licensing if there are any changes such as operating hours or status to her facility.

Appeal rights and notice of site visit was given and must be posted for 30 days. Exit interview conducted and report was reviewed with licensee Lakshmi Chinta


SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Kelly Phan
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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