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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500787
Report Date: 02/03/2023
Date Signed: 02/03/2023 03:04:18 PM

Document Has Been Signed on 02/03/2023 03:04 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CHEMUDUGUNTA, SWAPNAFACILITY NUMBER:
394500787
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
02/03/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Swaona ChemuduguntaTIME COMPLETED:
03:15 PM
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On 2/3/2023, Licensing Program Analyst’s (LPA1) Corina Beckby and (LPA2) Stacey Williams, met with Applicant (A1) Swapna Chemudugunta for the purpose of a pre-licensing inspection. LPA1 provided the Entrance Checklist to A1. Also present in the FCCH was A1's husband. Applicant and husband have criminal background clearance verified by LPA1 accessing Guardian. A1’s tentative hours of care are Monday through Friday, from 8:00 AM until 6:00 PM. A1 does not intend on providing overnight or weekend care.

A health and safety inspection was conducted inside and outside of the FCCH. A1 accompanied LPA’s for the entirety of the tour. The FCCH is a two-story house with a kitchen, living room, pantry, closet, loft, 4 ½ bathrooms, 5 bedrooms, and access to garage. A casita is attached to the home but has a separate entry. LPA1 verified that toxic and hazardous items were inaccessible to children in care. LPA1 observed cleaners stored in the kitchen and bathroom cabinets and both have child safety locks. LPA1 did not observe any fireplaces. LPA1 observed the stairs properly barricaded by a baby-gate. The outdoor play area was toured which has 2 side yards. LPA1 verified that the entirety of the backyard is fenced-in and walked the perimeter to ensure the safety of the fence and gate. LPA1 did not observe a pool, spa nor water feature. A1 stated not having pets. The OFF-limits areas of the FCCH are the kitchen, pantry, downstairs ½ bathroom, the closet, the entirety of the 2nd floor, garage, backyard, and the front yard. A1 understands that OFF-limit areas must remain inaccessible to children in care.

A functioning dual smoke and carbon monoxide detector was observed in the living room and tested. Medication is stored in the kitchen inside a top cabinet inaccessible to children. A 3A40BC fire extinguisher was observed in the closet and a first aid kit will be kept in daycare closet. A1 stated there are no firearms or weapons in the home.



Continues LIC 809C
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: CHEMUDUGUNTA, SWAPNA
FACILITY NUMBER: 394500787
VISIT DATE: 02/03/2023
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LPA1 discussed Mandated Reporter Training with A1. Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their Mandated Reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English and Spanish. A1 has a current Mandated Reporter Training Certificate which will expire on 8/19/2024. Current Pediatric CPR and First Aid training was verified and expires on 8/6/2024. Completion of Preventative Health and Safety training including nutrition and lead exposure was verified before the inspection. Proof of required immunizations for A1 was also verified before the inspection.

A1 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.

As of today, 2/3/2023, the license will be pending the livescan criminal clearance of individuals of the casita. A livescan form was given to applicant for individual residing in casita and was agreed to contact LPA1 when individual is livescanned.

An exit interview was conducted, and the report was reviewed with A1, Swapna Chemudugunta. Licensee Appeal Rights were provided.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC809 (FAS) - (06/04)
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