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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409235
Report Date: 02/14/2022
Date Signed: 02/14/2022 01:17:28 PM


Document Has Been Signed on 02/14/2022 01:17 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:BOSTAN, MAGDAFACILITY NUMBER:
073409235
ADMINISTRATOR:BOSTAN, MAGDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 334-2048
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:14CENSUS: 0DATE:
02/14/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Magda BostanTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Cherie Acosta met with applicant Magda Bostan for an announced Prelicensing Inspection. Present during the inspection was the applicant and her husband Ashraf Bostan. Applicant states that the hours of operation will be 6:00am - 6:30pm Monday through Friday. Applicant submitted COVID -19 Self-Assessment Guide. LPA reviewed responses with applicant and provided technical assistance.

The home was toured for a Health and Safety Inspection. This is a two story . The first floor of the home consists of a living room, dinning room, bathroom, kitchen, family room/child care room and garage. The second floor consist of three bedrooms, two bathrooms and laundry room. The area that will be used for child care will be the family room/child care room and kitchen. The remainder of the home will be off limits to children. Off limits area will be made inaccessible by use of gates closed and/or locked doors and visual supervision. The home is neat and clean with heating and ventilation for safety and comfort. The isolation area will be the kitchen dining area. The fenced backyard will be used for the outdoor play area. There are age appropriate toys in the home. There are no pools, hot tubs or any other similar bodies of water at this home. There are no firearms in the home as stated by the applicant. LPA did not observe any hazardous materials or toxins accessible to children today. The home is equipped with a working smoke detector and carbon monoxide detector. There is a working telephone in the home. The home has a fully charged 2A10BC fire extinguisher. The home has a gas fireplace. Fire place will not be used during child care hours as stated by the applicant. Stairs are located in the off limits area of the home. Applicant has a gate to prevent access to the off limits area of the home.
The applicant has current CPR/First Aid which expires 2/13/24. Applicant completed mandated reporter training 12/30/21. Applicant is in compliance with required immunizations. Proof of control of property was verified. A copy of the grant deed was obtained. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2022
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: BOSTAN, MAGDA
FACILITY NUMBER: 073409235
VISIT DATE: 02/14/2022
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LPA discussed the safe sleep regulations with applicant 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 applicant 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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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

Applicant has applied for a large license. Licensure is pending fire clearance approval.

Exit interview conducted and report was reviewed with Magda Bostan.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie AcostaTELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC809 (FAS) - (06/04)
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