073402949-9-25-2019-02-CC-PPEN-BGCQGK-20190925120939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402949
Report Date: 09/25/2019
Date Signed: 09/25/2019 12:09:46 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ALI, SAUSAN		FACILITY NUMBER:	073402949
ADMINISTRATOR:	ALI, SAUSAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 525-0193
CITY:	EL CERRITO	STATE: CA	ZIP CODE:	94530
CAPACITY:	14	CENSUS: 9	DATE:	09/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Sausan Ali		TIME COMPLETED:	12:10 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	Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced random annual inspection for this facility at 1015. LPA met with licensee, Sausan Ali, and there were nine children in care consisting of three infants and six preschoolers. Also present was assistant, Aesha Ahmed. Licensee provided LPA with a current DOJ Applicant Fingerprint Response for Ms. Ahmed. This facility was within ratio and capacity. The on limits areas for children in care is the lower floor only including the main play room, the nap room, the smaller classroom and the children's bathroom. All on limits areas were inspected for a health and safety inspection. Electrical outlets are safety capped. Hazardous items/toxins are stored inaccessible to children in care. Furnishings and equipment, including infant sleeping equipment and play items, are age appropriate and free of observed sharp/broken pieces. There is heating, ventilation and air conditioning present for temperature management. Per staff, the most recent fire department inspection was within the past two months. The facility has a working smoke detector, working carbon monoxide detector and fully charged fire extinguisher. The disaster drill log is current. Per licensee there are no firearms stored or present on the premises. The back yard/outdoor play area is fully fenced and available to children in care with direct adult supervision present at all times children are using the outdoor area. The swings/slide are securely anchored. Licensee is reminded to frequently check all wooden play equipment for splintering/loosening and repair as needed. There are no pools, hot tubs or other accessible bodies of water. All required postings are present including parents' rights and facility license. Continued on Page 2*************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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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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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ALI, SAUSAN	FACILITY NUMBER: 073402949
	VISIT DATE: 09/25/2019

NARRATIVE

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This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. The following information 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 reviewed the facility, staff and children's records including parents' rights forms, emergency ID forms and consent for emergency medical treatment forms. Licensee has current CPR/First Aid certification which expires 11/2019.

The Safe Sleep Awareness Campaign PIN packet was provided and discussed. Licensee is encouraged to visit www.ccld.ca.gov for licensing regulations and forms. To sign up for quarterly updates contact: childcareadvocatesprogram@dss.ca.gov.

There were no deficiencies cited during this inspection. A notice of site visit was printed and is to remain posted for thirty days. A copy of this report was provided to licensee and is to be maintained in the facility records for a period of three years.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

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