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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406112
Report Date: 12/20/2019
Date Signed: 12/20/2019 11:04:37 AM

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:RAZA, NAZREENFACILITY NUMBER:
073406112
ADMINISTRATOR:RAZA, NAZREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 325-8415
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:14CENSUS: 2DATE:
12/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:NAZREEN RAZATIME COMPLETED:
11:00 AM
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LPA Tasha Alexander met with licensee Nazreen Raza for an unannounced ANNUAL/RANDOM inspection. Present for the inspection were licensee, and 2 preschool age children in care. LPA toured the facility and backyard for a health and safety inspection. The children's files contained emergency information and immunization blue cards. The home is equipped with a 3A40BC fire extinguisher, working smoke detector and working carbon monoxide detector. There is a working telephone in the home. Per licensee there are no fire arms on the premises. There are no pools, hot tubs, or other bodies of water at the home. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR and 1st Aid training which expires 5/2021 respectively. The off limits areas are master bedroom/bath, laundry room and garage. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates.
A review of staff records on 12/20/19 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption. Licensee has immunization records in file today.

The newly mandatory mandated reporter training course was discussed today. Licensee has a certificate of completion posted today. The certificate expires this month (December), licensee is reminded to renew the certificate BEFORE the end of this month.

The new safe sleep practices for infants was also discussed today. Licensee has one infant in care. Licensee also has play pen for infant sleeping.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: RAZA, NAZREEN
FACILITY NUMBER: 073406112
VISIT DATE: 12/20/2019
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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

As a result of this visit, there are no deficiencies cited today. This report must be available for public review for 3 years. An exit interview was conducted. A notice of site visit was posted.


SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2