013418111-11-13-2019-52-CC-BPLY-BHVS28-20191113122906

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418111
Report Date: 11/13/2019
Date Signed: 11/13/2019 12:29:17 PM

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, SOFIA		FACILITY NUMBER:	013418111
ADMINISTRATOR:	MASOOD, SOFIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 825-3099
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	14	CENSUS: 12	DATE:	11/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Sofia Masood		TIME COMPLETED:	01:00 PM

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 11/13/19, Licensing Program Analysts Briana Plumboy and Junell Chen, met with licensee Sofia Masood for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was fingerprint clear and associated assistant Monowara Begum, fingerprint clear and associated assistant Sharmin Kadri, licensee's teenage daughter, 3 infants, and 9 preschool age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:00am until 6:00pm. 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, family room, living 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 BACKYARD play area is fenced and has a storage area which licensee is aware the door must be closed and secured at all times. The left and right sides of the backyard are off limits to children in care. LPA Plumboy informed licensee at no times shall children be in off limits areas. The center of the yard has multi color cushioning covering the ground. There are ample age appropriate toys and play equipment which are requiring maintenance. There are no pools, hot tubs or any other bodies of water present at the facility today. 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, and assistant Sharmin Kadri's CPR and First Aid certificates are current and expire 04/06/2021. The licensee's mandated reporter training is complete and she received a certification of completion on 05/02/18. The two assistants present today currently have waivers for the mandated reporter training. The licensee and both assistants present are in compliance with the immunization law. The fireplace is screened to prevent access by children. See 809-C and 809-D for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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: 11/13/2019

NARRATIVE

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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 08/04/19. (2) Children files were reviewed. Facility roster was reviewed. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

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 Plumboy provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, 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

See 809-D for deficiency cited today. Appeal rights provided and explained. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/13/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/29/2019 Section Cited	1 2 3 4 5 6 7	The home shall be free from defects or conditions which might endanger a child. This requirement was not met as evidenced by:Based on the tour of the backyard during the inspection, the backyard play area
	8 9 10 11 12 13 14	was found to have defects and is in need of cleaning as well as the fence is not in its original form and is in need of repair. These areas that need repair/maintenance pose a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

LIC809 (FAS) - (06/04)

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