414004629-11-26-2019-05-CC-JSAI-BJAR8K-20191126114804

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004629
Report Date: 11/26/2019
Date Signed: 11/26/2019 11:48:21 AM

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:	REHMANE, AMNA		FACILITY NUMBER:	414004629
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	11/26/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rehmane, Amna		TIME COMPLETED:	12:00 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) Jyoti Saini conducted an announced pre licensing inspection today for a change of location and met with Licensee Amna Rehmane. The facility was previously licensed at 1610, Albemarle way Burlingame CA 94010 license number 414004423. The facility submitted a change of location application on September 23, 2019. The purpose of this inspection is explained. LPA Saini inspected the entire home with applicant Amna Rehmane for health and safety hazards. Adults living in the house are Licensee and her husband. All adults living in the house have cleared criminal record. Day care area are: family room, dinning room, bathroom #1 and backyard. Off limit areas are: Garage, master bedroom #1, Bathroom #2( inside the master bedroom), Bedroom #2, bedroom 3, Kitchen and dinning area #2 attached to the kitchen. Applicant operates family day care from 8:30AM- 5:30PM Monday through Friday. Applicant rents the home and provided control of property on the day of visit. LPA observed the following today: Day-care area is clean, orderly, and equipped with age appropriate toys and equipment for the children. No baby walkers, bouncers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged fire extinguisher. Applicant states there are no guns or weapons of any kind in the home. Fireplace is barricaded appropriately. Electrical outlets have child protective covers in place making them inaccessible to children. Detergents, cleaning compounds, medications and other items of this nature are made inaccessible to children. Bathroom cabinets/drawers have child protective covers in place making the aforementioned items inaccessible to children.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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: REHMANE, AMNA	FACILITY NUMBER: 414004629
	VISIT DATE: 11/26/2019

NARRATIVE

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Licensee’s CPR and First Aid expires March 2021. Applicant has completed 16 hours preventative health practices training. Applicant understands emergency drills must be conducted at least once every six months and properly logged. Applicant will provide daily snacks but lunch will be provided by parents. Discipline used will be talking and redirection. Inspection of required posted forms was made. Consultation was provided regarding Smoking prohibition, SIDS, Shaken Baby Syndrome. Applicant is not planning to provide care to infant at this time.

Licensee advised that all adults 18 years and older either living or working in the home must have fingerprint clearance and current TB testing. Failure of an adult 18 years or older not being fingerprinted is a Violation of Section 102370(d) will result in a citation of a deficiency and an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department.

Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption. pursuant to Health and Safety code 1596.7995 and 1597.662.

Licensee was informed about the Provider Information Notices (PINs) on CCLD website.

Licensee was reminded about Mandated Reporter Training available on CCLD website.
(www.ccld.ca.gov or www.mandatedreporterca.com).

Small Family child care license will be recommended to be granted.

This report will be kept in the facility file and will be made available for public review upon request. Desk duty is available Monday - Friday, 8:00AM -5:00PM. (650) 266-8800. Website for forms and Regulations: www.cdss.ca.gov.

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

LIC809 (FAS) - (06/04)

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