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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422131
Report Date: 02/07/2020
Date Signed: 02/07/2020 09:37:36 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:ALI, NAZIAFACILITY NUMBER:
013422131
ADMINISTRATOR:ALI, NAZIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 952-9914
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 12DATE:
02/07/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Nazia AliTIME COMPLETED:
09:45 AM
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On 02/07/20, Licensing Program Analyst Briana Plumboy met with licensee Nazia Ali for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was fingerprint clear and associated assistants Quratulain Sheraz, Sabrina Ebadi, 4 infants, and 6 preschool age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:30am until 5:45pm.

The home is two stories. The ON LIMIT AREAS are the family room, garage, 1/2 bathroom, kitchen and backyard. The ISOLATION AREA will be a section in the family room. The children will enter through the side of the home and walk through the garage to get to the family room. The OFF LIMIT AREAS are the entire upper level of the home which consists of 4 bedrooms and 2 bathrooms and the lower level of the home living room which will be inaccessible by closed and/or locked doors and visual supervision. There is a child safety gate which acts as a barricade to the off limit areas. The BACKYARD play area is completely fenced. The anchored play structure has been removed from the facility since the last inspection and as of 01/06/20 the grass area in the backyard is on limits to children in care. The outskirts (garden) and deck on the right side of the backyard are off limits to children in care. There are toys that appear to be in good condition during today's inspection. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. All hazardous materials and toxins were observed to be kept out of the reach of children during the inspection. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide, and working telephone. The licensees CPR and First Aid certificate expires 11/10/20, Quratulain Sheraz's CPR/First Aid certificate expires 05/2021 and assistant Sabrina Ebadi's CPR/First Aid is current and expires 12/04/2020. The licensee received a certificate of completion in mandated reporter training on 01/20/19 and assistant Quratulain Sheraz received her mandated reporter training certificate on 11/20/18. The licensee and both assistants present today 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. Facility roster copy obtained. Licensee is in ratio today. Forms are visible for public review, and located inside the garage today. The facility last documented a disaster drill on 01/08/20. LPA Plumboy provided licensee with a copy of the CDSS handout on Effects of Lead Exposure. There are no deficiencies cited during today's inspection. This report shall remain on file for 3 years. A notice of site visit was given 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: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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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