434416731-7-27-2021-07-CC-MMOO-C5BR6A-20210727124424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416731
Report Date: 07/27/2021
Date Signed: 07/27/2021 12:44:39 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:	HAMID, YOUSUF		FACILITY NUMBER:	434416731
ADMINISTRATOR:	YOUSUF, HAMID		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 655-2444
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	14	CENSUS: 0	DATE:	07/27/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Hamid Yousuf		TIME COMPLETED:	12:00 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	On July 27, 2021 at 9:43 AM, Licensing Program Analysts (LPAs) Marilou Monico and Cortney Nelson conducted an announced prelicensing inspection in response to Applicant's request for a change of location application received by the Department. LPAs met with Applicant, Yousuf Hamid, and explained the purpose of today's inspection. LPAs note that Applicant was licensed at 229 Budd Avenue, Campbell, CA 95008 (Facility number: 434408372). 9:55 AM - Application/Record Review: Applicant is the only adult residing in the home. The Applicant resides in a one-storey, four-bedroom and two-bathroom house. Days and hours of operation will be Monday to Sunday from 6:00 AM to 11:00 PM. The Applicant's CPR and First Aid certification is current, with an expiration date of June 24, 2023. Applicant's Mandated Reporter Training for Child Care Workers expires on June 27, 2023. The Applicant rents the home and Property Owner/Landlord Notification (LIC 9151) form as well as verification of control of property were submitted. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's inspection. 10:15 AM - Physical Plant tour: There is a working telephone in the home (408) 655-2444. The home is clean and has heating and ventilation for safety and comfort. LPAs observed that there's a barricaded fireplace in the living room, barricaded wall heater in the detached daycare room, and gated kitchen/living room. The off limit areas inside the home: kitchen, living room, and one bedroom (applicant's bedroom). Off limit areas outside the home: two locked storage sheds. There are safe and age appropriate toys, play equipment, and materials for the children in the home. The Applicant has a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness. The home has working smoke/carbon monoxide detectors. Continuation on next pages:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

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: HAMID, YOUSUF	FACILITY NUMBER: 434416731
	VISIT DATE: 07/27/2021

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed with the Applicant. 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) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Applicant states that he does not plan on administering medication to the day care children at this time.

11:30 AM - Notification requirements/civil penalty: LPAs discussed the requirements of AB 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPAs discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. LPAs reminded the Applicant 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. 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.

During today's inspection, Applicant submitted updated Application for a Family Child Care Home License (LIC 279), Current Children in the Home (LIC 279B), lease agreement, Property Owner Landlord Notification (LIC 9151), and a letter to close facility #434408372.

Fire clearance was granted on July 16, 2021.

LPAs conducted an exit interview and advised the Applicant that a Large Family Child Care Home license will be approved upon completion of the following:

1) Health and Safety Training including Nutrition and Lead Poisoning Prevention
2) Manager's review and approval

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: HAMID, YOUSUF	FACILITY NUMBER: 434416731
	VISIT DATE: 07/27/2021

NARRATIVE

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Physical Plant tour (cont.): The Applicant has one fire extinguisher (2A10BC) in the home that is fully charged. The Applicant states that he does not have any firearms in the home. All cleaning compounds, sharp objects, medications, and other similar items are stored inaccessible to the children. The Applicant understands that baby walkers, baby bouncers, jumpers, and saucer chairs are not allowed in the home. The Applicant states that no one in the home smokes and he understands that smoking is prohibited in the home. The Applicant has a first aid kit in the home. There were no bodies of water observed.

10:30 AM - Kitchen tour: The refrigerator and freezer in the home is clean. The kitchen area is gated. The Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

10:40 AM - Bathroom tour: The toilets and faucets are clean, safe, and operable. The showers are free of any hazards. Sharp objects and cleaning products are stored inaccessible to children.

11:00 AM - Document/Regulation Review: A Family Child Care Home packet with updated Licensing forms was provided to Applicant. Documents from the packet, including but not limited to the following were discussed and reviewed with the Applicant: 1) Child Care Facility Roster (LIC 9140) must be complete and current at all times, 2) Fire/disaster drills must be practiced at least once every 6 months and documented on the fire/disaster drill log provided to the Applicant, 3) Posting requirements - Parent's Rights (PUB 394), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), and Facility License, 4) Staffing & Ratio - capacity/ratio limitations handout, 5) Safe Sleep Regulations (PIN 20-24-CCP), 6) Lead Flyer Requirement (PIN 20-01-CCP), and 7) Forms and Records to keep in your Family Child Care Home (LIC 311D).

Applicant states that he will use time out (maximum 1 minute per year of age) as form of discipline. The Applicant understands that children's personal rights should not be violated; including no corporal punishment, supervision of children, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Applicant.

Continuation on next page:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021

LIC809 (FAS) - (06/04)

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