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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410667
Report Date: 10/09/2019
Date Signed: 10/09/2019 04:18:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:HAMEED, NAILAFACILITY NUMBER:
434410667
ADMINISTRATOR:HAMEED, NAILA & ABDULFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 504-2270
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:14CENSUS: 0DATE:
10/09/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Naila HameedTIME COMPLETED:
04:30 PM
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On 10/09/19 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Plan Of Correction (POC) Inspection at Naila Hameed's family day care. LPA met with Licensee, Naila and explained the purpose of today's inspection. Licensee was issued citations during an annual/random inspection on 09/25/19.

LPA inspected the home and reviewed files. There were no medications, poisons or cleaners in accessible areas, all child records were contained required and complete licensing forms and documents. LIC9224 Statement Acknowledging receipt of Licensing Reports were kept in all child files. Licensee conducted and update fire drill log and children roster. Licensee states she transports children from their elementary schools, and does not employ anyone. All citations were cleared and Letters of Clearance given to Licensee. There were no children present during time of inspection.

No citations were issued today. This report was discussed with Licensee.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED NEAR THE ENTRANCE OF THE HOME FOR 30 CONSECUTIVE DAYS
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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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