013422131-1-6-2020-52-CC-BPLY-BKKRZC-20200106122742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422131
Report Date: 01/06/2020
Date Signed: 01/06/2020 12:27:50 PM

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, NAZIA		FACILITY NUMBER:	013422131
ADMINISTRATOR:	ALI, NAZIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 952-9914
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	14	CENSUS: 10	DATE:	01/06/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Nazia Ali		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/06/20, 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 06/03/2019, 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 07/08/19. 4 children files were reviewed and found to be complete. See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

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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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: ALI, NAZIA	FACILITY NUMBER: 013422131
	VISIT DATE: 01/06/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

LPA Plumboy provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 California Law requires Family Child Care Home 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.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, 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

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

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 Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

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: ALI, NAZIA	FACILITY NUMBER: 013422131
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/06/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES	PLAN OF CORRECTIONS(POCs)
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2020

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020

LIC809 (FAS) - (06/04)

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