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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422990
Report Date: 05/09/2019
Date Signed: 05/09/2019 02:28:39 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:IMRAN, HUMAFACILITY NUMBER:
013422990
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
05/09/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Huma ImranTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Julia Placencia arrived at 1:55pm for an unannounced case management inspection, and met with licensee Huma Imran. Present today were the licensee's fingerprint cleared sister, Ambreen Zafar, one preschooler and three infants.

The purpose of today's inspection is to determine if the facility is ready to be licensed for an increase in capacity. During Annual/Random inspection conducted on 4/19/19, licensee was advised to add more tan bark around the outdoor play structure. LPA observed today that licensee has added artificial turf, and some tanbark, under and around the play structure. Additionally, the department received the approved fire clearance from the City of Fremont on 1/11/19 to operate as a large family day care.

Licensee is approved today, 5/9/2019, to operate as a large family day care. A new licensee will be mailed within two weeks.

No deficiencies are cited during today's inspection. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days.

Exit interview conducted with Huma Imran, and copy of report provided.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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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