434415080-8-13-2019-07-CC-TDON-BEZUSZ-20190813155110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415080
Report Date: 08/13/2019
Date Signed: 08/13/2019 03:51:15 PM

COMPREHENSIVE INSPECTION

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:	SELIMOVIC, BELMA		FACILITY NUMBER:	434415080
ADMINISTRATOR:	SELIMOVIC, BELMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 603-8911
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY:	14	CENSUS: 8	DATE:	08/13/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Belma Selimovic		TIME COMPLETED:	04:00 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 Analysts (LPAs) Tuoc Doan and Pietro Hernandez conducted an unannounced Annual Inspection of the Family Day Care home. LPAs met with Licensee Belma Selimovic and explained the purpose of the inspection. Present during the inspection were eight children in care, of whom two were infant age. LPAs observed that Licensee, Licensee's Spouse, and Assistant Providers Judy Estrada and Shauna Perry were present to provide care and supervision to the children. Licensee stated that she understands that when she has more than 12 and up to 14 children, one child has to be attending school and one child has to be at least 6 years old. Licensee also stated that she understands she must comply with the capacity requirement of a small Family Child Care Home whenever there is only one care provider home with the children. The home’s operating days and hours are Monday through Friday from 07:30 AM to 06:00 PM. The home maintains telephone service. The License and Notification of Parents’ Rights were observed to be posted. The home was inspected inside and out. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. LPAs did not observe flies, other insects, or rodents during the inspection. The observed children’s toys, play equipment, and furniture were in good condition. There were no baby walkers at the day care. Bathroom used by children was observed to be clean and in operating condition. Food preparation area was clean. Areas inside the home that are off limits are: the one bedroom, living room, and two closets. The backyard is fenced and used for outdoor activity. There were no bodies of water observed. Licensee stated that there were no weapons stored on the premises. A fully charged fire extinguisher was observed. Carbon monoxide and Smoke Detectors were tested and proved to be functioning. Fire/Disaster Drills were last conducted on 06/12/19. Licensee stated that the day care does not provide transportation to the children. Licensee sometimes take the children to the local park. Licensee stated she will provide on-site supervision at all times when she takes the children to play at outdoor play space that is not fenced.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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: SELIMOVIC, BELMA	FACILITY NUMBER: 434415080
	VISIT DATE: 08/13/2019

NARRATIVE

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LPAs reviewed and obtained a copy of the roster of children in care. Children’s files were reviewed, which included records of Identification and Emergency Information, Consent for Emergency Medical Treatment, Receipt for Parents' Rights Notice, and Immunization. Licensee and Assistant Providers Judy Estrada and Shauna Perry's files were reviewed, which included Criminal and Child Abuse Background Check Clearance, immunization record, required Training etc. Licensee's AB1207 Mandated Reporter Training expires on 01/27/2020 and her Pediatric CPR/1st Aid Certificate expires on 08/03/2021.

Adults who reside in the home are Licensee and Licensee's Spouse They have Clearances for Tuberculosis, and Criminal Background and Child Abuse Index Checks. LPAs 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.

LPAs reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, etc. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe Sleep information was also reviewed and provided to Licensee.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently does not have any children in care who requires IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm> .

In the areas that were evaluated, no regulatory violations were observed at the time of the inspection. Exit interview was conducted, where this report was reviewed with Licensee.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

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