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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415534
Report Date: 03/03/2023
Date Signed: 03/03/2023 11:35:28 AM


Document Has Been Signed on 03/03/2023 11:35 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:SALIMEI, OZRAFACILITY NUMBER:
013415534
ADMINISTRATOR:SALIMEI, OZRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 657-3651
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:14CENSUS: 4DATE:
03/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Ozra SalimeiTIME COMPLETED:
11:40 AM
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On March 3, 2023 at approximately 8:45am Licensing Program Analyst (LPA) Haderer arrived and met with the licensee Ozra Salimei for the purpose of conducting an unannounced 1-year annual inspection for Health and Safety. Present for today’s inspection was the licensee and 4 children in care (one 11-month old infant, two 2-years old; one 4-year old). The facility is in ratio. Also living in the home are licensee’s fingerprint and TB test cleared husband and their adult son.

The facility is licensed as large (up to 14 children), however, licensee operates as a small (maximum 8 children) without an assistant. Hours of operation are Monday - Friday 8:00am 6:00pm.

The facility is a single-story home with 3 bedrooms; 2 bathrooms; living room; family room; dining room; kitchen; laundry room; attached 2-car garage; front, back and side yards. There is water feature fountain in the off-limits area of the back yard, children are never allowed in the area. There is a screened fireplace in the off-limits living room. The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the hallway area away from the other children in care. All required postings are present.

ON LIMIT AREAS: Master bedroom (converted to a day care area); the master bathroom for children; hallway leading from the front door to the master bedroom; and the enclosed patio play yard area with a picket fence and artificial turf that is accessible only from the master bedroom (day care area). Cabinets in the children’s bathroom have child-proof latched on all doors. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. The gate latch for the enclosed on-limits children's patio play yard is rusty and starting to fail. OFF LIMIT AREAS: Remaining 2 bedrooms in the home; main house bathroom; kitchen; living room; family room; dining room; laundry room; attached 2-car garage; and backyard areas outside of the fenced in children’s area. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023
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 4


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: SALIMEI, OZRA
FACILITY NUMBER: 013415534
VISIT DATE: 03/03/2023
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The licensee has a friendly small toy poodle. Per licensee, the poodle is current with his canine shots.

The home has a fully charged 3A40BC fire extinguisher in the kitchen (lasted tested on 6-17-2022), smoke and carbon monoxide detectors (tested and working) and a working telephone. Fire drills are conducted monthly, the last drill was completed in January 2023. The licensee owns the property and has liability insurance provided by DCI Insurance and is in effect through July 2023.

Licensee has ample age-appropriate toys and learning materials inside and outside the home. The outdoor play area has a gate latch that is rusty and starting to fail. Children are supervised in the area, and due to the recent wet weather, children have not been going outside to play. Licensee will replace the gate latch to prevent children accessing off-limits areas of the back yard – see LIC809 for deficiency. Per licensee, there are no firearms in the home. Drop-down cribs are not allowed at the day-care facility. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

LPA reviewed facility files including records for licensee and Children’s files.

Licensee has required immunizations. CPR/1st Aid was available for licensee, expires 3/9/2024. Mandated Reporter was completed 6/20/2021. Licensee was reminded that CPR/1st Aide and Mandated Reporter is to be renewed every two years.

Children’s files were complete and well organized. The facility roster was reviewed, and a copy obtained. All files were complete and well organized. LIC9227 Infant Safe Sleep Plans were completed and signed by parents and available in the child’s file. Sleep logs were not maintained for infants from age birth to 24 months, see LIC809D for deficiency.

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.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: SALIMEI, OZRA
FACILITY NUMBER: 013415534
VISIT DATE: 03/03/2023
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

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.

There were two deficiencies issued this :


Missing infant sleep logs
Faulty gate latch on the fence in the on-limits patio play yard area.

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

Exit interview conducted and report was reviewed with the licensee Ozra Salimei.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/03/2023 11:35 AM - It Cannot Be Edited

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: SALIMEI, OZRA
FACILITY NUMBER: 013415534

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the gate latch for the enclosed children's play yard is rusty and starting to fail and will not latch properly which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2023
Plan of Correction
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Licensee will continue to supervise the children when they are outside and will replace the gate latch to prevent children accessing off-limits areas of the back yard.
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that infant sleep logs have not been maintained for children age birth to 24 months which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/06/2023
Plan of Correction
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Starting today, Licensee will begin documenting Labored breathing; Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness.; Infants up to 12 month of age who are sleeping in a position other than on their back and document shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: a. Date. b. Infant’s name. c. Time of each 15-minute check.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4