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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418111
Report Date: 02/28/2023
Date Signed: 02/28/2023 02:25:18 PM


Document Has Been Signed on 02/28/2023 02:25 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:MASOOD, SOFIAFACILITY NUMBER:
013418111
ADMINISTRATOR:MASOOD, SOFIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 825-3099
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 11DATE:
02/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Sofia Masood- LicenseeTIME COMPLETED:
02:40 PM
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On 2/28/23 at 12:54pm, Licensing Program Analyst Briana Plumboy met with licensee Sofia Masood for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was fingerprint clear and associated assistant Monowara Begum, 3 infants, and 8 preschool age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:30am until 5:30pm.

The home two levels. There is a gate located at the bottom of the stairs to prevent access to the stairs. The home has heating and ventilation for safety and comfort. The ON LIMIT AREAS are the garage, kitchen, living room, family room, downstairs bathroom, and downstairs bedroom which is located downstairs on the right side of the hallway. The OFF LIMIT AREAS are the downstairs master bedroom/bathroom, the bedroom located in the middle of the downstairs hallway, and the three bedrooms and bathroom located upstairs which will be inaccessible by closed and/or locked doors and visual supervision. The licensee is aware children may not eat or sleep inside the garage. The ISOLATION AREA will be the the living room. The FRONTYARD play area is fenced and licensee is aware at all times she must provide 100% physical and visual supervision. The backyard is off limits to children in care. LPA Plumboy informed licensee at no times shall children be in off limits areas. There are no play structures located in the front yard which are required to be anchored. There are toys and play equipment. There are no pools, hot tubs or any other bodies of water present at the facility today in the on limit areas. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee and her assistant Monowara Beguum's CPR and First Aid certificates are current and expire 05/2023. The licensee's mandated reporter training is complete and she received a certification of completion on 08/23/22 and assistant Monowara Begum currently has a waiver for the mandated reporter training. The licensee and assistant present are in compliance with the immunization law. The fireplace is 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 12/1/22. 5 Children files were reviewed. Facility roster was reviewed. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
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: MASOOD, SOFIA
FACILITY NUMBER: 013418111
VISIT DATE: 02/28/2023
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Incidental Medical Services (IMS) policy was discussed. 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

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

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Sofia Masood 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 Sofia Masood 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.

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

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Sofia Masood.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
LIC809 (FAS) - (06/04)
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