414004675-3-3-2020-05-CC-JSAI-BMCQ35-20200303104811

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004675
Report Date: 03/03/2020
Date Signed: 03/03/2020 10:48:17 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:	GOOMER, SEEMA		FACILITY NUMBER:	414004675
ADMINISTRATOR:	GOOMER, SEEMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 627-7206
CITY:	MILLBRAE	STATE: CA	ZIP CODE:	94030
CAPACITY:	14	CENSUS: 0	DATE:	03/03/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Goomer Seema		TIME COMPLETED:	11:15 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 Analysts (LPAs) Jyoti Saini and Cindy Interiano met License, Seema Goomer for a prelicensing visit today at this home. The purpose of this inspection was explained. This is a change of location from a previously licensed family child care home. The facility was previously licensed (# 414004315). Licensee submitted a change of location on February 05, 2020. Licensee stated she lives with her Husband and Adult Son. Present in the home is Licensee, Husband, and Adult son. Licensee is applying for a large family child care license with hours of operation: Monday through Friday 7:30 A.M. to 6:00 P.M. Capacity requirements were discussed today. Criminal record clearances are on file and will be transferred to this location. At 9:15am LPAs and Licensee inspected the entire house for health and safety hazards.

Day care areas are: first/lower level:'Veranda,' portion of backyard/Grass area, Daycare Room #1, Nap room #2, and Bathroom #1. Off limit areas are: first/lower level: Pool area in the backyard, Garage, sidyard, Entire upper level: Front yard, Living room, Kitchen, Bedrooms #3, #4, #5, and #6, and Bathrooms #2 and #3. All off limit areas, including closets, are properly barricaded.

Home has a swimming pool in the backyard. Pool has a secured pool cover, which has been bolted to the ground. Per licensee, pool cover can support the weigh of an adult. Pool area also has a secured fence. LPA advised licensee to keep it lock during operational hours of the day care.

The home has a multiple carbon monoxide, smoke detectors, and a fully charged fire extinguisher size 2A10BC. Facility has a working cell phone, and first aid/emergency kit supplies. Per Licensee, there are no firearms or weapons in the home. All sharp objects, cleaning supplies and other toxic items are stored out of reach of the children. Facility will be providing snacks and meals. Licensee's First Aid/CPR certificate expires in 10/21 Licensee is reminded of NO walker, exersaucers, jumpers, bouncers and any similar items to be used for children in care and shall be made inaccessible.

See Page 2. . .

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

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

FACILITY NAME: GOOMER, SEEMA	FACILITY NUMBER: 414004675
	VISIT DATE: 03/03/2020

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
26
27
28
29
30
31
32

Page 2. . .

During inspection,

· Licensee is advised all adults, 18 years and older living in the home, helper, or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CA Driver's License or CA ID prior to having any contact with children in care. Failure to do so may result in an immediate civil penalty of $100 per day

· Incidental Medical Services (IMS) policy was discussed.
· Licensee was reminded about having all Staff and Volunteers provide proof of immunization against influenza, pertussis, and measles or qualifies for an exemption.
· Licensee was reminded 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)
· Licensee was given information regarding ‘Safe Sleep’ practices.

This report is discussed and explained to the Licensee. Records to be Maintained in the facility was explained and left with the Licensee. Mandatory Posting Requirements: License, Emergency Disaster Plan, and Notification of Parents Rights Poster. An updated emergency disaster plan is obtained during an inspection.

Large Family Child Care License will be recommended once the fire clearence will be received .

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: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2