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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418111
Report Date: 09/01/2020
Date Signed: 09/01/2020 11:17:57 AM

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: 8DATE:
09/01/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sofia MasoodTIME COMPLETED:
11:30 AM
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On 09/01/20 at 11:00am, Licensing Program Analyst (LPA) B.Plumboy conduct an Announced Case Management virtual Tele Visit inspection. LPA Plumboy and Licensee Sofia Masood conducted a Facetime Meeting call. Licensee walked through her front yard and toured her FRONT YARD by video with LPA Plumboy. Present during today's visit was 2 fingerprint clear adults and 8 children in care (2 infants, 5 preschool age children, and 1 school age child). The facility currently operates Monday through Friday from 7:00am until 6:00pm.

The home is two stories. 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 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 living room. The FRONT YARD play area is completely fenced and as of 09/01/20 is included as an ON LIMIT area. The licensee is aware when children are playing in the front yard, there must be 100% visual and physical supervision on the children at all times.

This report shall remain on file for 3 years. A notice of site visit was emailed and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020
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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