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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394501061
Report Date: 08/06/2024
Date Signed: 08/06/2024 02:08:03 PM

Document Has Been Signed on 08/06/2024 02:08 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:GIRI, NIRMALAFACILITY NUMBER:
394501061
ADMINISTRATOR/
DIRECTOR:		GIRI, NIRMALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(317) 480-3184
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
08/06/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Nirmala GiriTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Erwin Tjhia conducted a case management inspection to verify corrections of deficiencies cited on 08/01/2024.

On 08/01/2024, the facility was cited for one Type A deficiency for operating out of ratio/capacity as there were 16 children present at the facility, including licensee’s 7 years old daughter and her friend who were in the off-limit area.


During today's inspection LPA toured all areas - including the off-limit areas - and observed 14 children including licensee's 7 years old daughter were supervised by licensee and husband.

The deficiency cited on 08/01/2024 for Ratio and Capacity can be cleared today.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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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