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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101501
Report Date: 05/31/2023
Date Signed: 05/31/2023 11:23:16 AM

Document Has Been Signed on 05/31/2023 11:23 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ARUMUGAM, ANNALAKSHMI FCCFACILITY NUMBER:
376101501
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/31/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Annalakshmi ArumugamTIME COMPLETED:
11:30 AM
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On 05/31/2023 at 9:30am, Licensing Program Analyst (LPA), Selina Siao conducted a pre licensing inspection with applicant. Present at the home today is applicant and her husband Solaimalai Subramanian. The 2 bedroom, 2 bath three level home was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fully charged fire extinguisher size 3A40BC,, smoke and carbon detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Applicant stated that home does not have any bodies of water or weapon. Applicant has an EMSA approved pediatric CPR and First Aid card that are current due to expire on 03/11/2025 and applicant completed the online mandated child abuse training on 03/08/2023 and it must be renew every two years. A review of the application and records on this date indicates that applicant and her husband are the current adult residents at the home with the require TB clearances, caregiver background checks and child abuse clearances. Applicant has the required immunizations. Applicant and her husband has control of the property and provided a copy of their grant deed to the department.

Applicant will be using the following areas for childcare: living room, bedroom and bath (main day care area) located at the lower level of the home and fenced backyard. The home has a fireplace located in the living that is blocked with a safety latch at the glass door and there is a yoga mat placed at the hearth to ensure children's safety. Off limit areas include: kitchen, loft and bedroom and hallway bath which there are safety gates at the bottom of the two stairways to prevent children access, the side yard is also off limit and there is a gate to prevent children's access

Applicant was reminded of requirements for children’s records, facility roster, child abuse and unusual incident reporting, immunizations, car seat law, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, baby walkers, exersaucers, bouncy seats and baby jumpers are not allowed in day care.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2023
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ARUMUGAM, ANNALAKSHMI FCC
FACILITY NUMBER: 376101501
VISIT DATE: 05/31/2023
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The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

Applicant shall comply with all regulations and laws governing family childcare homes and be financially secure to operate a family childcare home for children.

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, 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 up to $500.00 maximum per day/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.

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: http://www.ada.gov/childqanda.htm

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.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ARUMUGAM, ANNALAKSHMI FCC
FACILITY NUMBER: 376101501
VISIT DATE: 05/31/2023
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All unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203.

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 platform.

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.

The home appears to meet all licensing requirements, a license will be granted effective today.

Exit interview conducted and report was reviewed with the applicant.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC809 (FAS) - (06/04)
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