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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500519
Report Date: 03/13/2025
Date Signed: 03/13/2025 01:09:28 PM

Document Has Been Signed on 03/13/2025 01:09 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NAMBI, RAJALAKSHMIFACILITY NUMBER:
394500519
ADMINISTRATOR/
DIRECTOR:		NAMBI, RAJALAKSHMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 577-9795
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:11 PM
MET WITH:Rajalkshmi NambiTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On March 13, 2025, Licensing Program Analyst Stacey Williams conducted a case management inspection. LPA met with Licensee, Rajalkshmi Nambi. There were four children present with Licensee's Assistant.

LPA and Licensee discussed licensure and licensing documents during today's inspection.

An Exit interview was conducted, and the report was reviewed with Licensee, Rajalakshmi Nambi. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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