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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421458
Report Date: 03/14/2023
Date Signed: 03/14/2023 11:42:27 AM


Document Has Been Signed on 03/14/2023 11:42 AM - 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: 9DATE:
03/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Arifa Salayeva- LicenseeTIME COMPLETED:
11:55 AM
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On 3/14/23 at 10:18am, 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, 1 infants, and 8 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 into the facility at 10:21am. The facility currently operates Monday through Friday from 8:00am until 5:00pm.

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 is a bird bath located in the backyard and per licensee she never has standing water in the bird bath. Licensee stated she puts food in the bird bath for the birds only. Today, there is water in the bird bath due to the rain, but licensee is aware prior to children playing outside in the backyard she must empty the bird bath. 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 10:45am, and found she completed the course and received a certification of completion on 4/21/22 and assistant Rosie Salayev completed the mandated reporter training on 5/3/22. 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 11/30/22. At 10:49am, LPA Plumboy began a file review of 5 children files. At 11:06am, 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 for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023
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: SALAYEVA, ARIFA
FACILITY NUMBER: 013421458
VISIT DATE: 03/14/2023
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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.

No citations 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: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2