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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700352
Report Date: 12/22/2021
Date Signed: 12/22/2021 10:50:03 AM

Document Has Been Signed on 12/22/2021 10:50 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDAMBI, URMILAFACILITY NUMBER:
435700352
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/22/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Urmila KidambiTIME COMPLETED:
11:00 AM
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On Wednesday December 22, 2021 at 9:00 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an announced Pre-licensing Visit. LPA met with the applicant Urmila Kidambi. Applicant applied for a license to operate a Small Family Child Care Home with a maximum capacity of 8 at the address listed above. Applicant resides in the home with her spouse and the applicant's own children (a 8th Grader son and a 4th grader daughter). Present on this visit were the Applicant's spouse and applicant's own children. Applicant will be operating from (8:00 AM to 6:00 PM), Monday through Friday.

The home was toured with the applicant to conduct a health and safety inspection. The home is neat and clean with heating and ventilation for safety and comfort. The home is a one story home.

ON LIMITS: Day Care Bedroom, Day Care playroom, two (2) Day Care Bathroom, Study Room, the second Day Care Bedroom adjacent from the Family Room, front yard and the backyard. The isolation area will be the dining room.

OFF LIMITS: All the four (4) bedroom, Master Bathroom, Hallway Bathroom, Kitchen, Living Room, Family Room, Dining Room and the garage. All off limit areas will be inaccessible by closed and/or locked doors and visual supervision. The applicant was advised to contact Licensing, so that an inspection can be completed prior to changing an off limits area to on limits.

The outdoor play area will be the backyard, which has a fence surrounding the perimeter of the yard. There are ample age appropriate toys which are observed to be safe, clean and in good repair. There are no pools, hot tubs or any other bodies of water. LPA did not observe any hazardous materials or toxins accessible to children today. The home has a fully charged 3A40BC fire extinguisher which is located in the laundry room, working smoke detectors on the ceiling throughout the home, carbon monoxide detector and telephone.
***Continued on LIC 809C...
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDAMBI, URMILA
FACILITY NUMBER: 435700352
VISIT DATE: 12/22/2021
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The fireplace is screened to prevent access by children. Per applicant, there are no firearms in the home. A copy of the Applicant's Deed of Trust was reviewed and shows control of property. The applicant’s health and safety training has been completed on 09/19/2021, and First Aid/CPR certificate is current, expiring on 09/2023. The applicant has provided proof of the required immunization, and the required mandated reporter training was completed on 08/2021. Licensing forms were discussed. Safe Sleep practices were discussed, and new car seat laws were provided. Applicant was reminded that children are never to be left in a parked vehicle.
LPA reminded the applicant of the following; Mandated Reporter training and CPR/First Aid is to be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reporting Requirement.
Incidental Medical Services (IMS) policy was discussed. 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
Applicant 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.

LPA discussed the safe sleep regulations with the applicant 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 applicant 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.

This home is recommended for licensure today, 12/22/2021.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Applicant Kidambi Urmila.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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