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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423385
Report Date: 08/10/2023
Date Signed: 08/10/2023 11:43:18 AM

Document Has Been Signed on 08/10/2023 11:43 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BADEPALLI, HARITHAFACILITY NUMBER:
013423385
ADMINISTRATOR:HARITHA BADEPALLIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 307-8496
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
08/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Haritha Badepalli- LicenseeTIME COMPLETED:
12:00 PM
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On 8/10/23 at 9:15am, Licensing Program Analyst Briana Plumboy, met with licensee Haritha Badepalli for an UNANNOUNCED REQUIRED ANNUAL INSPECTION. Present for this visit was licensee's fingerprint clear and associated assistant Shinderpal Kaur, an unfingerprinted assistant (S2), 1 infant, and 8 preschool age children. The home was toured to conduct a Health and Safety Inspection. Per the fire clearance, "The above facility has been approved. There is no use of any bedrooms, the study room or the garage." The facility currently operates from 8:30am until 6:00pm.

The home is single story. The home consists of a kitchen, living room, family room, 3 bedrooms, 1 hallway bathroom, a master bedroom and bathroom, garage, and backyard. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the kitchen, ALL bedrooms, a master bedroom with a master bathroom, the left and right side of the backyard, and the garage which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, family room, hallway bathroom, and center area of the backyard. The ISOLATION AREA will be the living room. There is a safety gate located between the living room and kitchen, as well as across the door which leads to the garage. Outdoor play area will be located inside the backyard. The backyard is fenced. Licensee is aware any play equipment must meet manufacture instructions, CCLD regulations, and be in proper condition per manufacture prior to and while being used. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that during the inspection there are no toxins or hazardous items accessible to children in care.
The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR and First Aid certificate is current and expires 11/5/24, licensees assistant Shinderpal Kaur's is current and expires 11/5/24, and licensees husband's CPR/ First Aid certificate is current and expires 10/30/23. The licensee's mandated reporter training expired on 08/08/23, and her 2 assistants present have waivers for mandated reporter training until it is available in their native language. The licensee and her husband are in compliance with the immunization law which pertains to childcare providers. The fireplace is located inside the family room and is screened and barricaded to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills more than twice a year with the last earthquake conducted on 8/9/23 and the last fire drill conducted on 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: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BADEPALLI, HARITHA
FACILITY NUMBER: 013423385
VISIT DATE: 08/10/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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

Child Care Centers and Family Child Care Homes: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.



To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Family Child Care Homes Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

See 809-C and 809-D for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BADEPALLI, HARITHA
FACILITY NUMBER: 013423385
VISIT DATE: 08/10/2023
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The licensee provided proof of control of property.

LPA discussed the safe sleep regulations with and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility. Notice of Site Visit - Centers and Family Child Care Homes

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

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

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

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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Document Has Been Signed on 08/10/2023 11:43 AM - It Cannot Be Edited


Created By: Briana Plumboy On 08/10/2023 at 11:03 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: BADEPALLI, HARITHA
FACILITY NUMBER: 013423385

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above due to S2 not having a cleared livescan which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee took S2 to get fingerprinted on 8/9/23 and is awaiting clearance.
POC Due Date: 09/01/2023
Plan of Correction
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Licensee shall ensure that prior to working each staff's fingerprint clearance is cleared and associated with the facility. Licensee will check her guardian account to monitor S2's fingerprint status prior to S2's return to the facility she must have a clearance.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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 in S1 is missing TDAP and S2 is missing pertussis, influenza, and measles which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/08/2023
Plan of Correction
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On or before 9/8/23, licensee will provide the missing immunizations for both assistants to LPA Plumboy.
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: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


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