414004220-9-11-2019-05-CC-FBRR-BFWQVH-20190911123021

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004220
Report Date: 09/11/2019
Date Signed: 09/11/2019 12:30:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	JUKAKU, HATIFA		FACILITY NUMBER:	414004220
ADMINISTRATOR:	JUKAKU, HATIFA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 585-6869
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94401
CAPACITY:	14	CENSUS: 10	DATE:	09/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Hatifa Jukaku		TIME COMPLETED:	12:44 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 Analysts (LPAs) Faye Bremer conducted an unannounced Annual inspection. LPAs rang doorbell on the side door leading to the playground with no answer, and observed children playing with an adult present. LPA Bremer rang front doorbell and staff opened the door but did not allow LPA in. LPAs rang the doorbell, and knocked to the side door again and was allowed entry. LPAs met with staff and explained purpose of inspection. Licensee arrived sometime later. LPAs toured the physical plant with staff and observed 3 infants in one closed-door bedroom, who were crying loudly. Another infant was sleeping in the adjacent bedroom, with the door closed. LPA advised staff to assist the 3 crying infants. Upon Licensee's arrival, LPA informed Licensee of LPAs observations regarding the crying infants and the closed doors. Licensee informed LPAs that the crying infants were being sleep-trained, and parents were aware of this. Licensee informed LPAs that the doors were closed so that the infants would not be awakened by the sound of the other children. LPAs informed Licensee that per Safe Sleep Practices for the prevention of SIDS, doors need to remain open for sleeping infants to allow for visual observation. LPA reviewed Safe Sleep Practices with Licensee, and provided Licensee copies of Safe Sleep handouts. LPAs inspected the Day Care areas for any health and safety hazards. Day Care areas consist of: the backyard, Bedroom #1 and #2 which are used for napping only, Bedroom # 3/Kids room, Office/Room adjacent to the Kids room, bathroom #2 inside bedroom #3, backyard and side yard. Off limit areas are: Living room, dining room, kitchen, bathroom # 1, entire upstairs level, and front yard. All disinfectants are kept locked and inaccessible to children. Per Licensee, she has a cat, but the cat stays outdoors during operating hours. Outdoor play area is fenced and free from dangerous conditions. Home does not have any bodies of water, and the fireplace in the living room is blocked by a sofa. A sufficient amount of clean, age appropriate toys in good repair are available for the children. Continues on the following page.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye Bremer	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JUKAKU, HATIFA	FACILITY NUMBER: 414004220
	VISIT DATE: 09/11/2019

NARRATIVE

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Continued from previous page.

LPAs reviewed child and staff files. Childrens records have all required assessments and agreements on file. Staff files have all required documents.

Licensee is not providing Incidental Medical Services (IMS) at this time 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

No deficiencies cited during today's inspection.
Report reviewed and provided to Licensee Hatifa Jukaku

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye Bremer	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

LIC809 (FAS) - (06/04)

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