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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700352
Report Date: 11/29/2023
Date Signed: 11/29/2023 04:58:19 PM

Document Has Been Signed on 11/29/2023 04:58 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDAMBI, URMILAFACILITY NUMBER:
435700352
ADMINISTRATOR:KIDAMBI, URMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 261-3281
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/29/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Urmila KidambiTIME COMPLETED:
03:00 PM
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On Wednesday, November 29, 2023 at 2:20 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced visit. LPA met with the Licensee Urmila Kidambi and explained the nature of site visit. Present on this visit were the 2 Assistant Provider (NISHA and HAMSAVANI), 3 infants and 4 preschool children. Home is operating from 8:30 AM to 6:00 PM, Monday through Friday.

LPA toured the home with the Licensee 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.

The on-Limit Areas are the 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 front yard and backyard play area is completely fenced. The isolation area for a child who becomes ill while in care is the family room.

The Off Limit Area are all the four (4) bedroom, Master Bathroom, Hallway Bathroom, Kitchen, Living Room, Family Room, Dining Room and the garage which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision. There are ample age-appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. The fireplace is screened to prevent access by children on the off limit area. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year. Licensee owns the house, does carry childcare liability insurance with Acord.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDAMBI, URMILA
FACILITY NUMBER: 435700352
VISIT DATE: 11/29/2023
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The licensee CPR and First Aid certificate expires in August 2025 and one of the Assistant Provider's CPR and First Aid certificate expires on 06/27/2025. The licensee and the 2 Assistant Provider completed the Mandated Reporter Child Care Providers training online at https://mandatedreporterca.com/ in 4/5/2023, 8/20/2022 and 4/7/2023, respectively. The licensee and the 2 Assistant Provider have records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, LIC 9150, Sleep Logs, LIC 9227 and and Immunization. The licensee is in ratio today. The Licensee does not transport children currently.

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

LPA 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.

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.

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

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDAMBI, URMILA
FACILITY NUMBER: 435700352
VISIT DATE: 11/29/2023
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There are no deficiencies cited on this visit.

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

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

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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