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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422131
Report Date: 02/28/2023
Date Signed: 02/28/2023 10:51:08 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/28/2023 10:51 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:ALI, NAZIAFACILITY NUMBER:
013422131
ADMINISTRATOR:ALI, NAZIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 952-9914
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: DATE:
02/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Nazia Ali- LicenseeTIME COMPLETED:
10:55 AM
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On 2/28/23 at 9:06am, Licensing Program Analyst Briana Plumboy met with licensee Nazia Ali for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was licensees fingerprint clear and associated daughter Marium Ali and 1 infants. 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 (for pick up and drop off with parents only/ the garage side door is the entrance and exit the licensee uses for access to the childcare), 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 childcare. 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. There are no anchored play structures. 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 08/03/23. The licensee received a certificate of completion in mandated reporter training on 2/21/22. The licensee is 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 02/11/22 due to licensees facility being closed until this month. Licensee is aware she must conduct a fire drill within the next week. 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: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
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: 02/28/2023
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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 Nazia Ali 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 Nazia Ali 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 deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Nazia Ali.

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

DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023
LIC809 (FAS) - (06/04)
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