073407616-11-19-2024-52-CC-MPRE-DB6UWD-20241119145635

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407616
Report Date: 11/19/2024
Date Signed: 11/19/2024 04:44:07 PM

Document Has Been Signed on 11/19/2024 04:44 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:	KARUMURI, PADMAJA		FACILITY NUMBER:	073407616
ADMINISTRATOR/ DIRECTOR:	KARUMURI, PADMAJA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 984-2296
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	11/19/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:05 PM
MET WITH:	Padmaja Karumuri		TIME VISIT/ INSPECTION COMPLETED:	02:55 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 11/19/2024 at 1:05pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Padmaja Karumuri for an unannounced annual/random inspection. Present during the inspection was the Licensee, her adult helper, four (4) infants and two (2) preschool age children. Licensee’s husband was present in the home, upstairs, in an off-limit area. Licensee lives in the home with her husband and their adult son. Licensee’s home was toured for a health and safety inspection. The facility operates from 9:00am – 5:30pm, Monday – Friday. ON LIMITS AREA: Living Room, Study (used as a playroom), Dining Area, Kitchen, Downstairs Bathroom and Backyard OFF LIMITS AREA: Entire 2^nd Floor and Garage ISOLATION AREA: Living Room The facility is a two-story home owned by the Licensee. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children’s learning and play. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children and all food that may be brought from the children’s home will be properly labeled and stored. Licensee uses infant high chairs and feeding chairs for meal times. LPA observed all napping equipment to be properly stored and well maintained. LPA provides play yards, and mats for the children. Licensee provides all bedding for the children as well. All off-limit areas in the home are made inaccessible with locks, gates, and closed doors. Licensee stated she does not transport children, there are no firearms and no pets in the home. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

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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Document Has Been Signed on 11/19/2024 04:44 PM - It Cannot Be Edited

Created By: Morgan Pringle On 11/19/2024 at 02:25 PM

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: KARUMURI, PADMAJA	FACILITY NUMBER: 073407616
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)(1)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Three (3) infants present needed updated immunization records. Based onrecord review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/22/2024
	Plan of Correction
1 2 3 4	Licensee will obtain updated records from the childrens authorized representatives by end of day Friday, 11/22/2024. Licensee will send LPA Pringle a copy of all missing immunization records as proof of correction.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Jason Jang

LICENSING EVALUATOR NAME:

Morgan Pringle

LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: KARUMURI, PADMAJA	FACILITY NUMBER: 073407616
	VISIT DATE: 11/19/2024

NARRATIVE

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During LPAs inspection, LPA observed an 11-month-old infant sleeping in a play yard with a blanket. LPA informed Licensee that there should not be any objects in the play yard while an infant is sleeping. Licensee immediately removed the blanket.

LPA observed one (1) fully charged 3A40BC fire extinguisher in the kitchen pantry. There is one (1) working smoke/carbon monoxide detector in the living room, and one (1) smoke detector in the study. The electric fireplace in the living room is not in use and does not get hot to the touch. The staircase is gated making it and the second floor inaccessible to the children in care. The home is equipped with central heat and air for proper ventilation.

The backyard is fully fenced and well maintained with ample age-appropriate materials for the children. LPA observed fruit trees and vegetable gardens around the backyard as well. LPA did not observe any unattended or harmful bodies of water in or around the home.

The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been complete and EMSA approved Pediatric CPR & First Aid training is complete and expires 10/22/2025. Licensee’s Mandated Reporter training is complete and expires 9/25/2025. LPA obtained the fire/disaster drill log. Fire/disaster drills have been conducted and recorded within the last six (6) months with the last drill logged 6/3/2024. LPA verified all adults living and working in the home have obtained a criminal record clearance. All required forms are currently posted by the front door of the home. LPA obtained a sample of the children’s files, the helpers files, and facility files. Through record review it was found that three (3) infants needed updated immunization records (see LIC809-D). All other documents were complete.

Deficiencies cited during LPA inspection

Three (3) infants need an updated immunization record on file

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

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: KARUMURI, PADMAJA	FACILITY NUMBER: 073407616
	VISIT DATE: 11/19/2024

NARRATIVE

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Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's authorized representatives, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days of the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. Licensee was reminded that any structural changes or additions to the home must be reported to CCLD. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Padmaja Karumuri, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: KARUMURI, PADMAJA	FACILITY NUMBER: 073407616
	VISIT DATE: 11/19/2024

NARRATIVE

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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.

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-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Padmaja Karumuri.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024

LIC809 (FAS) - (06/04)

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