013422990-3-9-2022-52-CC-RHAR-CCCUXN-20220309145838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422990
Report Date: 03/09/2022
Date Signed: 03/09/2022 02:59:02 PM

Document Has Been Signed on 03/09/2022 02:59 PM - 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:	IMRAN, HUMA		FACILITY NUMBER:	013422990
ADMINISTRATOR:	HUMA IMRAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 373-5988
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	14	CENSUS: 5	DATE:	03/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Huma Imran		TIME COMPLETED:	02:59 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 March 9, 2022 at approximately 11:50am Licensing Program Analyst (LPA) Haderer met with the licensee Huma Imran for the purpose of conducting an unannounced 1-year annual inspection for Health and Safety compliance. Present for today’s inspection was the licensee, her TB and fingerprint cleared assistant and 5 children in care (3 infants and 2 toddlers). Hours of operation are 9:00am to 5:30pm. The facility is a single-story home with 3 bedrooms, 2 bathrooms, a kitchen, dining room, living room, and an attached 2-car garage, front, back and side yards. There is no fireplace in the home. The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the on-limits bedroom on the right side of the hallway away from the other children in care. ON LIMIT AREAS: Living room; dining room; kitchen; house bathroom on the right side of the hallway; the first bedroom next to the house bathroom on the right side of the hallway; entire backyard. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. OFF LIMIT AREAS: The master bedroom and second house bedroom on the left side of the hallway and the attached 2-car garage. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision. The home has a fully charged 2A10BC fire extinguisher in the living room, smoke detectors and carbon monoxide detector (all tested and working) and a working telephone. Fire drills are conducted every 4 to 6 months, the last drill was completed on 2-23-2022.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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: IMRAN, HUMA	FACILITY NUMBER: 013422990
	VISIT DATE: 03/09/2022

NARRATIVE

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There is a large play structure in the backyard that is free from hazards and has soft materials underneath. Children are supervised at all times while playing. Licensee has ample age-appropriate toys and learning materials inside and outside the home. Per licensee, there are no firearms in the home. The home has approved cribs and play yards for infant sleeping, baby bouncers & drop-down cribs are not allowed at the day-care facility. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

At 1:30pm, LPA reviewed facility files including records for licensee and assistants and the Children’s files. The licensee’s Health and Safety training is completed. Both the licensee and assistant have current CPR and First Aid certificates, both expire 10-16-2023. Mandated Reporter training was completed 5/15/2021 (licensee), assistant was completed 5-16-2021. Licensee was reminded that CPR/1st Aide is to be renewed every two years. The licensee is in compliance with the immunization laws which pertains to day care providers.

Children’s files were complete and well organized. The facility roster was reviewed, and a copy obtained. All files were organized and complete. The licensee owns the property, does not carry liability insurance. All LIC 282 forms Notice of no Liability Insurance signed and dated in each child’s file.

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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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: IMRAN, HUMA	FACILITY NUMBER: 013422990
	VISIT DATE: 03/09/2022

NARRATIVE

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LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

LPA reviewed guidance on operating safely during the Covid pandemic. Posters were present and the checking in process of children was reviewed.

There were no deficiencies issued today. The report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Huma Imran.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC809 (FAS) - (06/04)

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