344500204-7-26-2021-53-CC-ASIA-C5ATNC-20210726145232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500204
Report Date: 07/26/2021
Date Signed: 07/26/2021 02:52:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	AHMED, SHABANA & MUSTAFA, HUMA		FACILITY NUMBER:	344500204
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	07/26/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Huma Mustafa		TIME COMPLETED:	02:35 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) Amy Silva met with Licensee, Huma Mustafa. The purpose of today's inspection was for a capacity increase from a small family child care home with a maximum capacity of 8 children to a large family child care home with a maximum capacity of 14 children. LPA toured all on-limit areas of the home that are accessible to children. The off-limit areas in the home include: bedrooms one and three, kitchen, laundry room, and garage. Off-limits areas will remain inaccessible to children by closed doors and/or supervision LPA observed Licensee Huma Mustafa supervising five children. LPA observed a current roster of the enrolled children and a fire drill log. Licensee conducts monthly fire drills. LPA observed the fire extinguisher, carbon monoxide detector, smoke detectors and fire pull station to be in compliance with Health and Safety Code and Title 22. LPA observed current CPR/First Aid certificate and a current Mandated Reporter training certificate for Licensee. The Fire Safety Inspection Clearance was received 7/16/21 from the Elk Grove Fire Department and the home has been cl.eared to operate with up to 14 children. Licensee acknowledges that when there is no assistant present, facility will revert back to the requirements for a small family child care home. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity. 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. Report continued on 809C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: AHMED, SHABANA & MUSTAFA, HUMA	FACILITY NUMBER: 344500204
	VISIT DATE: 07/26/2021

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LPA reviewed with Licensee the handouts “A Child Care Provider’s Guide to Safe Sleep” and “Safe Sleep Regulations,” Safe Sleep Log Requirements and "Lead Poisoning Facts."

Effective today 7/26/21, LPA Silva is granting the Licensee, Amber Hammond, a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children with 1 child in kindergarten or elementary school and 1 child at least age 6 with no more than a maximum of 3 infants. Infants are children under the age of 2 years old.

Also during today's inspection, Licensee requested to change bedroom number two, located behind the kitchen from "off-limit" status to "on-limit" status. The bedroom was inspected and determined to be in compliance with Title 22 regulations. As of 7/26/21, bedroom number two is approved to be on-limits and utilized by children in care.

An exit interview was conducted. In the areas that were evaluated, no deficiencies were observed at the time of the visit. LPA reviewed report with Licensee and provided a copy. Appeal rights provided. Notice of Site Visit was provided and Licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC809 (FAS) - (06/04)

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