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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500787
Report Date: 02/16/2023
Date Signed: 02/16/2023 10:44:46 AM

Document Has Been Signed on 02/16/2023 10:44 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
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: 0DATE:
02/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Swapna ChemuduguntaTIME COMPLETED:
11:00 AM
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On 2/16/23, Licensing Program Analysts (LPA’s) Corina Beckby and Elvira Sierra conducted a follow up prelicensing visit and met with applicant, Swapna Chemudugunta.

The purpose of the inspection was to verify the adult occupant living in the casita adjacent to the home with the same address was cleared via Guardian. Guardian reports a clear and eligible status for the occupant in the home. LPA’s advised that when the occupant leaves, to contact Guardian and remove occupant from their list.

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’s reviewed and provided all necessary documents on LIC311D to applicant.

Effective today February 16, 2023, the facility is licensed to serve a MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

An exit interview was conducted, and the report was reviewed with Applicant, Swapna Chemudugunta. Licensee Appeal Rights were provided.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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