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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500870
Report Date: 06/14/2023
Date Signed: 06/14/2023 02:17:30 PM

Document Has Been Signed on 06/14/2023 02:17 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BANALA, VIJAYA LAKSHMIFACILITY NUMBER:
394500870
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/14/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Vijaya Lakshmi BanalaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Erwin Tjhia met with Licensee, Vijaya Lakshmi Banala for the purpose of conducting a change of location inspection. Present during the inspection was Licensee's husband and children. Licensee is requesting a change of location from old facility with license #394500617 to current location.

Licensee was reminded that all adults 18 and over living or working in the home, 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. During the visit today, licensee stated there was an unfingerprinted adult that was living and renting the guest room at the house. The guest's room has separate entrance but was located on the same address.

The facility is a two story home that consists of 5 bedrooms and 4 bathrooms. LPA and Licensee toured the entire home inside and outside. Off limit areas consist of the the garage, master bedroom/bathroom, entire upstairs, and guest room with separate entrance . Licensee acknowledged that children are never allowed in the off limit areas. Off limit areas will remain inaccessible by door handle covers, locked closed doors and supervision. Licensee understands that 100% supervision is required when children play any unfenced areas.

LPA discussed licensing requirements with Licensee including the posting of licensing inspection notices and reports, as well as injury and incident reporting. Fire extinguisher and first aid kit is located in the kitchen. Smoke alarm and carbon monoxide detectors were observed to be in operational order.

Report Continue on 809-C
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2023
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BANALA, VIJAYA LAKSHMI
FACILITY NUMBER: 394500870
VISIT DATE: 06/14/2023
NARRATIVE
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Licensee stated there are no weapons in the home. There are no bodies of water on the property. Hazardous items and personal hygiene items are made inaccessible to children. Sharp utensils are stored in locked drawers. Licensee has a current Mandated Reporter Training Certificate that expires 05/17/2024. Current pediatric CPR and first aid training was verified and expires 01/22//2024.

LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. LPA observed a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months during today's inspection. Licensee currently does not have any children enrolled that require IMS.

LPA also discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA discussed IMS services and the requirement to create a plan of operation. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Report Continue on 809-
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BANALA, VIJAYA LAKSHMI
FACILITY NUMBER: 394500870
VISIT DATE: 06/14/2023
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at
https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The license for Small Family Child Care Home could not be granted today. Prior to issue license, facility needs to complete the following:
- Have all adults living in the house to be fingerprinted cleared and associated to the facility, or all adults that renting and living on the guest room move out.

Exit interview conducted and report was reviewed with the licensee. Records, postings and reporting requirements were discussed. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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