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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700267
Report Date: 06/19/2024
Date Signed: 06/19/2024 02:30:25 PM

Document Has Been Signed on 06/19/2024 02:30 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:PINJALA, SUKANYAFACILITY NUMBER:
075700267
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/19/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Sukanya PinjalaTIME VISIT/
INSPECTION COMPLETED:
02:27 PM
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On 6/19/2024 at 12:00pm Licensing Program Analyst (LPA) Morgan Pringle met with Applicant Sukanya Pinjala for an Announced Pre-Licensing Inspection. Present during the inspection was the Applicant, her husband her mother and mother-in-law. Applicant lives in the home with her husband, her mother, and her mother-in-law. Applicant’s home was toured for a health and safety inspection. The facility plans to operate 8:00am – 5:30pm, Monday - Friday.

ON LIMITS AREA: Entire 1st floor (Converted Garage used as the classroom area, living room, family room, kitchen, downstairs ½ bathroom), and backyard
OFF LIMITS AREA: Entire 2nd floor (Four (4) bedrooms and two (2) bathrooms)
ISOLATION AREA: Family Room (room with the fireplace)

The facility is a single-story home owned by the Applicant. The home consists of four (4) bedrooms, two (2) bathrooms, one (1) half bathroom, living room, family room, and backyard.

The inside of the home is observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, and hazardous materials have been made inaccessible to the children. All off limit areas in the home have been made inaccessible with closed doors, locks, and gates. The home has centralized heat and air for proper ventilation. Applicant stated that all children’s bedding will be brought from home, and applicant will provide sleeping mats for the children. Applicant stated she is currently unsure if she will be providing all food for the children. Applicant will also not be providing transportation. There is a 2A10BC fire extinguisher in the converted garage.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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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: PINJALA, SUKANYA
FACILITY NUMBER: 075700267
VISIT DATE: 06/19/2024
NARRATIVE
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 There is one (1) working smoke/carbon monoxide detector in the upstairs hallways, all four (4) bedrooms, in the converted garage and in the living room. The stairs are gated making the second floor and the staircase inaccessible to the children in care. The electric fireplace in the family room is locked, and a locked cover has been placed over the switch making it inaccessible to the children. The backyard is fully fenced with ample space for the children to play. There were no harmful bodies of water observed in or around the home. Applicant stated there are no firearms and there is one (1) small dog in the home.

The Applicants Health and Safety training has been completed and Pediatric CPR and First Aid certificate is current and expires 10/2025. Applicants Mandated Reporter training is complete and expires on 8/4/2025. All adults living in the home have obtained a criminal record clearance. Applicant has provided immunizations for influenza, measles, pertussis and has a current record of tuberculous.

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

LPA reviewed with Applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.


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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
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: PINJALA, SUKANYA
FACILITY NUMBER: 075700267
VISIT DATE: 06/19/2024
NARRATIVE
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

On this date, 5/15/2024 the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.


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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
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: PINJALA, SUKANYA
FACILITY NUMBER: 075700267
VISIT DATE: 06/19/2024
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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) or (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.

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.

LPA has verified that all requirements have been met during this inspection and a license for a small family child care home is approved today, 6/19/2024.

Exit interview conducted and report was reviewed with the applicant, Sukanya Pinjala.









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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC809 (FAS) - (06/04)
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