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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419660
Report Date: 03/07/2023
Date Signed: 03/07/2023 12:15:56 PM


Document Has Been Signed on 03/07/2023 12:15 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:RAHMAN, NASREENFACILITY NUMBER:
013419660
ADMINISTRATOR:RAHMAN, NASREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 683-9953
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:14CENSUS: 8DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Nasreen RahmanTIME COMPLETED:
12:20 PM
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On 03/07/2023, Licensing Program Analyst (LPA) Melanie Otsuji, met with licensee Nasreen Rahman for an UNANNOUNCED 1 YEAR REQUIRED INSPECTION. Present was an additional fingerprint cleared staff, 3 infants and 5 preschool aged children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 8:00am until 5:30pm.

The home is two story home which consists of 5 bedrooms and 4 bathrooms. The ON LIMIT areas are: downstairs bedroom, downstairs bathroom, sunroom, kitchen/dining room, and living room. All other rooms/areas are off limits including garage and entire second floor. Off limit areas are barricaded by way of closed doors and or gates. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water on the premises during today’s inspection. The home has a fully charged fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Per licensee, there are no firearms in the home. Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.

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
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: RAHMAN, NASREEN
FACILITY NUMBER: 013419660
VISIT DATE: 03/07/2023
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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 Nasreen Rahman.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
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