013417501-2-28-2024-52-CC-BPLY-D2VP9M-20240228100721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417501
Report Date: 02/28/2024
Date Signed: 02/28/2024 10:07:33 AM

Document Has Been Signed on 02/28/2024 10:07 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	MUKALED, BASIMA		FACILITY NUMBER:	013417501
ADMINISTRATOR:	MUKALED, BASIMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 648-0152
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	14	CENSUS: 9	DATE:	02/28/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Basima Mukaled- Licensee		TIME COMPLETED:	10:20 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 2/28/24, Licensing Program Analyst Briana Plumboy met with licensee Basima Mukaled for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this inspection was 9 children in care which consist of 2 infants, 7 preschool age children, and licensee's fingerprint clear and associated assistant Rhea Walker. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:30am until 5:30pm. The home is a two story home. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the entire downstairs except the laundry room and garage. The OFF LIMIT AREAS are the garage, laundry room, and entire 2nd level of the home which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the living room. The BACKYARD play area is fenced. There are toys and learning equipment. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR and First Aid certificates is current and expires 08/27/24 . The licensee's mandated reporter training is complete and she received a certification of completion on 1/17/24 and her assistant present received her certificate on 2/28/24. The licensee and assistant present today are in compliance with the immunization law. There are 2 fireplaces located inside the home. One fireplace is located inside the family room and the other inside the living room, they are both screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 10/11/23. The licensee is in ratio today. See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MUKALED, BASIMA	FACILITY NUMBER: 013417501
	VISIT DATE: 02/28/2024

NARRATIVE

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Licensee is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

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 platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MUKALED, BASIMA	FACILITY NUMBER: 013417501
	VISIT DATE: 02/28/2024

NARRATIVE

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Licensee Basima Mukaled was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA discussed the safe sleep regulations with licensee Basima Mukaled and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed licensee Basima Mukaled 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.

During the exit interview, the Licensee Basima Mukaled confirmed that there are no Registered Sex Offenders living in the facility.

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

No deficiencies today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Basima Mukaled.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC809 (FAS) - (06/04)

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