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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421458
Report Date: 04/07/2022
Date Signed: 04/07/2022 12:07:59 PM


Document Has Been Signed on 04/07/2022 12:07 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:SALAYEVA, ARIFAFACILITY NUMBER:
013421458
ADMINISTRATOR:SALAYEVA, ARIFAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 477-0939
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 8DATE:
04/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Arifa Salayeva- LicenseeTIME COMPLETED:
12:20 PM
NARRATIVE
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On 4/7/22 at 9:50am, Licensing Program Analyst (LPA) Briana Plumboy, met with licensee Arifa Salayeva for an UNANNOUNCED ANNUAL REQUIRED INSPECTION. Present for this visit was licensee's fingerprint clear and associated husband Rahim Salayev, licensee's fingerprint clear and associated daughter/assistant Rosie Salayeva, 3 infants, and 5 preschool age children. The home was toured by LPA Plumboy and licensee Arifa Salayeva to conduct a Health and Safety Inspection upon LPA Plumboy's arrival at the facility at 9:50am. The facility currently operates Monday through Friday from 8:00am until 6:00pm.

The home is two stories. The ON LIMIT AREAS are the 2 patio rooms, and downstairs bathroom. The children walk through the family room/dining room to go to the bathroom and licensee is aware they must be supervised at all times. The OFF LIMIT AREAS are the kitchen, dining room, family room, garage, living room, downstairs bedroom, laundry room, and entire second level of the home. There is a child safety gate located between the family room and patio room. The ISOLATION AREA will be the family room. The BACKYARD play area is fenced. There are toys and learning materials present during today's inspection. There are no pools, hot tubs or any other bodies of water present in the on limit areas during the inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that during the inspection there are no toxins or hazardous items accessible. The licensee provided current day-care insurance to LPA Plumboy.

The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone (all which were tested and checked during the inspection by LPA Plumboy). The licensee's CPR and First Aid certificate is current and expires 3/12/24, and assistant Rosie Salayva's expires 6/16/23. LPA Plumboy reviewed the licensee's mandated reporter training certificate at 11:08am, and found she completed the course and received a certification of completion on 3/30/19 which is now expired, assistant Rosie Salayev has not completed the mandated reporter training. The licensee and Rosie 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 1/31/22. At 10:08am, LPA Plumboy began a file review of 6 children files. At 9:56am, the facility roster was reviewed and a copy was obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C and 809-D for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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: SALAYEVA, ARIFA
FACILITY NUMBER: 013421458
VISIT DATE: 04/07/2022
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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 Arifa Salayeva 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 Arifa Salayeva 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.

See 809-D for citation cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Arifa Salayeva.

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

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/07/2022 12:07 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: SALAYEVA, ARIFA
FACILITY NUMBER: 013421458

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
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 record review, the licensee did not comply with the section cited above due to her and her assistant Rosie Salavya not having current mandated reporter training certificates which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
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Training can be found at mandatedreporterca.com.
The licensee and licensee's assistant must complete the mandated reporter training by 5/6/22 and submit to LPA by email or mail.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
LIC809 (FAS) - (06/04)
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