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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500285
Report Date: 04/20/2021
Date Signed: 04/23/2021 02:35:44 PM

Document Has Been Signed on 04/23/2021 02:35 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:VENKITACHALAM, RAMYAFACILITY NUMBER:
394500285
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
04/20/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ramya VenkitachalamTIME COMPLETED:
09:45 AM
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Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Stacey Williams is conducting a tele-video inspection via FaceTime with the licensee Ramya Venkitachalam. The purpose of today's inspection is to add the backyard into the on-limits area of the facility. All adult individuals subject to criminal background review have obtained a criminal record clearance and are cleared through the department. LPA observed two children supervised by the Licensee.

During today's inspection LPA conducted a health and safety tour of the backyard area with the Licensee. During the tour LPA and Licensee discussed the areas that would be made available in the back yard to children in care. Licensee requested the entire backyard be on limits. The entire backyard is fenced. LPA did not observe any hazards or chemicals in the backyard during the tour. The remaining off limit areas will remain the same: Main body of the home- Living room, family room, dining room, kitchen, and all bedrooms, upstairs, and the garage.

LPA requested an updated facility sketch of the outside area. LPA requested the off-limit areas labeled on the sketch.

Based on today's inspection, 4/20/2021, Licensee's backyard will be added to the on-limit areas. An exit interview was conducted. A copy of this report notice of site visit and appeal rights were emailed to the Licensee for signature. Hard copy of the report with signature will be on file.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2021
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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