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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625196
Report Date: 03/07/2025
Date Signed: 03/07/2025 03:09:19 PM

Document Has Been Signed on 03/07/2025 03:09 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KOPPULA, VIJAYA LAKSHMIFACILITY NUMBER:
343625196
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/07/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Vijaya Lakshmi KoppulaTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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Licensing Program Analyst Erwina Pascual-Golamco and Soleil Marx (LPA) met with Licensee, Vijaya Lakshmi Koppula, for the purpose of an unannounced case management inspection. No children in care at time of LPA visit. Licensee has requested to increase from a small family childcare to a large family childcare. Fire clearance STD850 was received and granted on 02/27/25 by SMFD.

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee 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, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Childcare Home. 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. LPA verified with Licensee that her associations are current. Facility hours of operation are Monday through Friday 8:30AM – 5:30 PM.

A health and safety inspection were conducted in the areas accessible to children. Off-limit areas include: ENTIRE 2ND FLOOR, PANTRY IN KITCHEN, GARAGE, AND BACKYARD. Licensee acknowledged that children may never enter these off-limit areas.

continued on LIC809-C...
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KOPPULA, VIJAYA LAKSHMI
FACILITY NUMBER: 343625196
VISIT DATE: 03/07/2025
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LPA discussed ratios for a large capacity and personnel records. Licensee understands that her own children under the age of 10 count towards the total ratio and capacity. Licensee understands that when there is no assistant present, the facility reverts back to the ratios of a small capacity. LPA provided a copy of CCR Regulation 102416.5 which discusses Ratio and Capacity. LPA discussed required documentation for adult and minor assistants.

Effective today, 03/07/25, the Facility is approved for a Large Family Child Care Licensed to serve 12 children (when there is an assistant present) with no more than 4 infants, or maximum capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants.

In the areas that were evaluated, no deficiencies were observed. Exit Interview was conducted, a Notice of Site Visit was provided, and must remain posted for 30 days for parental review.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC809 (FAS) - (06/04)
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