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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419185
Report Date: 06/28/2022
Date Signed: 06/28/2022 01:39:35 PM


Document Has Been Signed on 06/28/2022 01:39 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:BEGUM, SHANAZFACILITY NUMBER:
013419185
ADMINISTRATOR:BEGUM, SHANAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 709-5205
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:14CENSUS: 4DATE:
06/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Shanaz BegumTIME COMPLETED:
01:50 PM
NARRATIVE
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On June 28th, 2022 @ 10:45am Licensing Program Analyst (LPA) April Wright arrived unannounced for an Annual/Random inspection and met with Licensee Shanaz Begum. Present during this inspection were 1 infant and 3 preschool children. Also present in the home is the licensee's fingerprint nd cleared spouse and adult daughters age 21 and 26 year old. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:00am to 7:00pm.

The home is a single story, which is neat and clean, with heating and ventilation for safety and comfort. The entire house is used for childcare. There was a gate between the living room and hallway/kitchen areas to prevent access by children as well as visual supervision. The outdoor play area is fenced, and there is a locked storage unit in the yard. There are ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

The home has a fully charged 2A10BC fire extinguisher, working carbon monoxide and smoke detectors, telephone, and first aid kit. The licensee Pediatric CPR and First Aid certificate is current and expires 4/9/24. The fireplace has a child proof lock to prevent access by children. Per licensee, there are no firearms in the home. Licensee was reminded that children are never to be left in a parked vehicle. Children's files were reviewed. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. The licensee, spouse and daughters have proof of TB clearance. Safe Sleep practices were discussed with licensee. Earthquake Preparedness

The following deficiencies were observed during today's inspection:

ยท At 11:25am LPA observed that licensee has not completed Mandated Reporter Training.

Type A deficiency is cited today( Please see attached LIC809-D)

Continued on LIC809C

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
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: BEGUM, SHANAZ
FACILITY NUMBER: 013419185
VISIT DATE: 06/28/2022
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. No IMS proved at facility. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

California Law requires Child Care Homes 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.

Licensee was reminded that all adults 18 and over, 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 childcare center. 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.



The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. The licensee was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370)

LPA discussed the Safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep web page 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.


A notice of site visit was given and must remain posted 30 days. Exit interview conducted and report was review with Licensee Shanaz Begum.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/28/2022 01:39 PM - It Cannot Be Edited

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: BEGUM, SHANAZ
FACILITY NUMBER: 013419185

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview,record review, the licensee did not comply with the section cited above in that provider does not have completed mandated reporter training, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2022
Plan of Correction
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Licensee will take Mandated reporter training by th due date listed above and submit certificate competion to our office .
Type A
Section Cited
HSC
1596.8662(c)
Administration of Child Day Care Licensing
(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in which Licensee has not taken Mandated reporter training, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2022
Plan of Correction
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Licensee will take training by due date listed above and submit certificate of completion by due date.

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 NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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