013417919-1-31-2023-52-CC-MOTI-CNLRGT-20230131120116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417919
Report Date: 01/31/2023
Date Signed: 01/31/2023 12:01:28 PM

Document Has Been Signed on 01/31/2023 12:01 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:	ZAMAN, PURBA		FACILITY NUMBER:	013417919
ADMINISTRATOR:	ZAMAN, PURBA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 353-9758
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	14	CENSUS: 6	DATE:	01/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	Purba Zaman		TIME COMPLETED:	12:10 PM

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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced on today's date, 01/31/2023, to conduct a Required - 1 Year inspection. LPA was met by Licensee Purba Zaman. Present during today's visit was a fingerprint cleared staff member, Licensee's fingerprint cleared spouse and 6 children (4 infants, 2 preschoolers). LPA conducted a health and safety inspection inside and outside.

ON LIMIT AREAS: Living Room, Dining Room, Family Room, Bathroom at the end of the hall

All other rooms are off limits. Off limit areas are barricaded by way of closed doors or gates. There are no pools, spas, or similar bodies of water on the premises. Per Licensee, there are firearms on the premises. Firearms, firepins and ammunition are stored and locked separately from each other. Storage areas for poisons are inaccessible. Detergents and other cleaning compounds that can pose a danger to children are stored where inaccessible. A fully charged fire extinguisher was observed. Carbon monoxide and smoke detectors were observed to be operable as part of the Nest system. The home is kept clean, and orderly with ventilation for safety and comfort. LPA observed safe toys, play equipment and materials. The home has a working telephone on site. Outdoor play areas are fenced and supervision is provided while children are outside. On today's date, Licensee was within the proper capacity for their large family child care home license. All individuals present during today's date had the proper criminal record clearance. Each child's file contained the appropriate documentation. Mandated reporter was taken on 2/19/2022.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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: ZAMAN, PURBA	FACILITY NUMBER: 013417919
	VISIT DATE: 01/31/2023

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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.

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.

No deficiencies noted on today's date. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Purba Zaman.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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