073406522-2-21-2020-52-CC-JPLA-BLZNX7-20200221095040

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406522
Report Date: 02/21/2020
Date Signed: 02/21/2020 09:50:46 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	SIDDIQUE, AFSHAN		FACILITY NUMBER:	073406522
ADMINISTRATOR:	SIDDIQUE, AFSHAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 361-0246
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94583
CAPACITY:	14	CENSUS: 8	DATE:	02/21/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Afshan Siddique		TIME COMPLETED:	10:05 AM

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) Julia Placencia arrived at 8:30am for an unannounced Required-1 Year Inspection, and met with Licensee Afshan Siddique and fingerprint cleared spouse Affif Siddique. Present for this inspection were two infants, six preschoolers and fingerprint cleared helper Farzana Perveen. Also residing in the home is the licensee's fingerprint cleared daughter and son. The home was toured with the licensee and spouse to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 7:30am to 6:30pm. ON LIMITS: Entire home, side yard (patio). OFF LIMITS: Garage, backyard. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. The home is two levels, which are neat and clean, with heating and ventilation for safety and comfort. Day care is located on the bottom level and there are child safety gates at the top and bottom of the stairs. The outdoor play area is the fenced side yard patio, which is free from defects and dangerous conditions. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Fire extinguisher, carbon monoxide and smoke detectors meet State Fire Marshall standards. The fireplace is screened and has a glass cover to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills monthly, and the log indicates a drill was conducted 2/6/20. All required licensing documents are posted and visible for public review. At 9:15am, children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. The licensee's Pediatric CPR/First Aid certificate is current and expires 9/14/21. Licensee has proof of the required immunizations. Licensee is currently exempt from completing the mandated reporter training as English is not her first language. Safe Sleep practices were discussed, and new car seat laws were provided. Licensee was reminded that children are never to be left in a parked vehicle. ***Continued on LIC 809C...

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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: SIDDIQUE, AFSHAN	FACILITY NUMBER: 073406522
	VISIT DATE: 02/21/2020

NARRATIVE

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Individual 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 is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, 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 encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

There were no deficiencies cited during today's inspection. This report shall remain on file for 3 years. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days.

Exit interview conducted with Affif Siddique, and copy of report provided.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

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