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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500381
Report Date: 06/01/2021
Date Signed: 06/01/2021 02:05:24 PM

Document Has Been Signed on 06/01/2021 02:05 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:CHIGULLAPALLI, ALIVENIFACILITY NUMBER:
394500381
ADMINISTRATOR:CHIGULLAPALLI, ALIVENIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 404-9677
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/01/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Aliveni Chigullapalli TIME COMPLETED:
02:00 PM
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NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via FaceTime was conducted. On Tuesday, June 01, 2021, at 01:00 p.m. Licensing Program Analyst (LPA) Elvira Sierra returned to the facility at issue to conduct an inspection for a change of location this day and met with applicant Aliveni Chigullapalli and her husband. With the help of the Applicant and Applicant's husband LPA inspected entire home for Health and Safety Hazards and verified requested corrections from inspection dated 05/24/21. The following corrections were observed;

-COVID-19 posters were displayed at the entry of the home with the parents rights poster and emergency disaster.
-Child proof locks were installed in the requested areas.
- Latches were purchased and applicant will submit proof of correction to LPA once latches are installed in the kitchen cabinets.
- Stove covers were purchased and Applicant will submit pictures to LPA with the correction.
- Sanitation station was observed at the entrance of the home (thermometer and hand sanitizer)

Applicant stated that she will get more napping equipment as she enrolls more children and will request parents to provide napping equipment if needed. LPA advised Applicant facility should have an individual crib, cot, sleeping bag, bed, mat or pad for each child. No child should simultaneously share a crib, bed or bedding with another child. Mats and cots should be made with a waterproof material that can be easily washed and sanitized. No child should sleep on a bare, uncovered surface. Applicant stated she understood and will make sure bedding or any special sleep item is stored separately from those of other children.  

License will be granted pending installation of stove covers and cabinets latches in the kitchen. In lieu of applicant's signature, LPA is e-mailing the report with a read receipt request to applicant. Please note: When a physical inspection takes place, requests for alterations may be made


SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2021
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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