434411741-5-23-2019-07-CC-SYIP-BCFVZB-20190523165227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434411741
Report Date: 05/23/2019
Date Signed: 05/23/2019 04:52:33 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:	FARID, SALMA		FACILITY NUMBER:	434411741
ADMINISTRATOR:	SALMA FARID		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 268-5708
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95120
CAPACITY:	14	CENSUS: 7	DATE:	05/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:44 PM
MET WITH:	Salma Farid		TIME COMPLETED:	05:00 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) Samantha Yip conducted an unannounced annual random inspection. LPA met with Licensee Salma Farid and explained the reason for the inspection. Present at the beginning of the inspection were Licensee, her adult daughter (who helps with day care children), and 7 school age children. The hours of operation are Monday, Wednesday, Thursday, and Friday 3PM to 6PM and Tuesdays 2PM to 6PM. LPA toured the inside and outside of the home with Licensee. The off-limit areas of the home are all four bedrooms, the laundry room, and the garage. The home was clean and orderly for the children in care. There are no stairs in the home. The fireplace is barricaded to prevent access by children. Disinfectants, cleaning solutions, sharp, and other items that are dangerous to children in care were stored inaccessible and out of reach of children. LPA observed a fully charged fire extinguisher, carbon monoxide, and smoke detector. The last earthquake drill was conducted on 03/11/2019. The backyard is fenced and used for outdoor activity space. There is a treehouse in the backyard. There were no bodies of water observed during inspection. Licensee stated there is no weapons, such as firearms, stored in the home. Licensee does transport children at this time and has a valid driver's license. Licensee understands that no child shall be left alone and unattended in parked vehicles. Facility rosters was reviewed and a copy was obtained. 7 children’s files were reviewed during today inspection. The records reviewed included but not limited to Identification and Emergency Information and parent's rights.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: FARID, SALMA	FACILITY NUMBER: 434411741
	VISIT DATE: 05/23/2019

NARRATIVE

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Licensee and her daughter's CPR/ First Aid expires on 02/2020. Licensee stated that she completed a Mandated Reporter Training through San Jose State University. Licensee will send proof of training to Licensing office. Licensee has immunization record for pertussis and will obtain immunization record for measles.

LPA discussed Senate Bill 792 (immunization records for pertussis, measles, and flu vaccines), which began in 2016 for anyone working with the children and Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at http://www.mandatedreporterca.com.

Adults who are over the age of 18 and reside in the home are Licensee, her spouse, and adult daughter. All adults living the home have cleared criminal records, child abuse index clearance, and TB clearance. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Licensee stated that she currently does a child in care who requires Incidental Medical Services (IMS). Medication is stored where it is out of reach of children in care and with proper documentation. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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.

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

No deficiencies were cited as a result of today's inspection. An exit interview was conducted, where this report was discussed with Licensee

A NOTICE OF SITE VISIT WAS ISSUE AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019

LIC809 (FAS) - (06/04)

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