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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414724
Report Date: 02/20/2020
Date Signed: 02/20/2020 03:30:29 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:KHURRAM, TAHIRAFACILITY NUMBER:
434414724
ADMINISTRATOR:KHURRAM, TAHIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 390-9810
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:14CENSUS: 5DATE:
02/20/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Tahira KhurramTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA), Marilou Monico, conducted an unannounced 1-Year Required Inspection. LPA met with Licensee, Tahira Khurram, and explained the purpose of the visit. Also present during the inspection were licensee's assistant, Sanayya Kazmi, and five children including three infants and two preschool age. Licensee and her husband are the adults residing in the home.

The home’s operating days and hours are Monday through Sunday from 7:30 AM to 10:00 PM. The home has a working telephone service. The License, Notification of Parents’ Rights, Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The home was inspected inside and out. The home was clean. LPA did not observe flies, other insects, or rodents during the inspection. LPA observed sufficient materials, toys, and play equipment for the day care children. Bathroom used by children was observed to be clean and in operating condition. Food preparation area was clean. The kitchen was gated.

Areas inside the home that are off limit to day care children are master bedroom, master bathroom, bedroom #1, kitchen, furnace closet, and garage. Off limit areas outside the home: gated side yard and barricaded area of the backyard. There were no bodies of water observed. Licensee stated that there were no weapons stored on the premises. A fully charged 3A40BC fire extinguisher was observed. There were functioning carbon monoxide detector and smoke detectors. Fire/disaster drill was last conducted on September 10, 2019. LPA reviewed and obtained a copy of the roster of children in care.

Four children's files and Sanayya's file were reviewed. Licensee completed Assembly Bill (AB) 1207 Mandated Reporter Training. Licensee's AB1207 expires on March 7, 2021. Licensee & Sanayya have current Pediatric CPR/1st Aid certifications with an expiration date of July 2020. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. AB 633 was discussed with Licensee. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

Continuation on next page:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KHURRAM, TAHIRA
FACILITY NUMBER: 434414724
VISIT DATE: 02/20/2020
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A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee was encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.
Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA reviewed and provided licensee a copy of the “Lead Poisoning Facts Information and Safe Sleep Flyer. Provider Notice Information (PIN) summary for Child Care Center lead testing of drinking water and back up generator safety requirements were also provided.

Incidental Medical Services (IMS) Plan to administer Epipen was previously submitted to Licensing

As a result of this inspection, there were no deficiencies cited.



NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
LIC809 (FAS) - (06/04)
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