444415860-5-7-2019-07-CC-ZHAM-BBXPUU-20190507113807

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444415860
Report Date: 05/07/2019
Date Signed: 05/07/2019 11:38:18 AM

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:	MAZLOOM, SEDIQUE		FACILITY NUMBER:	444415860
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/07/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Sedique Mazloom		TIME COMPLETED:	11:45 AM

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) Zaid Hakim conducted an Announced Pre-Licensing Inspection at the prospective facility today. Upon arrival, LPA met with Ms. Sedique Mazloom, Licensee Applicant. The Licensee Applicant, her spouse, and one minor child are the only individuals that reside in the home and all adults maintain valid fingerprint clearance. The applicant has been previously licensed at another location and has since moved which requires a new application and department approval. The applicant has been advised that in the event of another adult moving into the home permanently they must obtain fingerprint clearance and TB test results prior to doing so. Immunizations are also required for any adults that engage in care and supervision of day care children. Days and Hours of operation will be Monday through Friday 8:00am to 5:30pm. The applicant maintains valid pediatric CPR and First Aid certification with an expiration month of 04/2021, has also completed the 8 hours Preventive Health, Safety, & Nutrition and the Required Mandated Reporter Training per AB 1207. The applicant stated that she is still evaluating liability insurance and has agreed to submit a copy to Community Care Licensing (CCL) if insurance is obtained. LPA toured all indoor and outdoor day care areas during the inspection. The day care areas approved for use include: three bedrooms downstairs, one one restroom, the living room, the kitchen, and a portion of the backyard as an outdoor play area. All other areas / bedrooms in the home are off-limits which includes the garage and the entire second floor which is a common area and one bedroom. Children will enter the day care through the side area yard which is secured with a gate. The applicant has an area designated for required postings, children's personal items, and children / personnel files. LPA observed door locks and barricade gates to secure items and areas that are to be inaccessible to children. LPA observed a barricade gate securing the stairs leading up to the second floor. LPA observed at minimum 1 fully charged 2A10BC fire extinguisher, functional smoke and carbon monoxide detectors, and first aid supplies in the home. The applicant has been informed that all fire safety detectors / equipment are to be maintained or replaced at least once every 12 months. The kitchen was observed to have functional appliances. The applicant stated that she will be serving snacks to children and lunches and meals will be brought from home. The applicant stated that parents will be informed of what foods may be served at the facility at any given time via a menu and understands that food allergies and dietary restrictions shall be followed and outlined in children's files. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 05/07/2019):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019

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: MAZLOOM, SEDIQUE	FACILITY NUMBER: 444415860
	VISIT DATE: 05/07/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 05/07/2019):

The applicant stated that there are no firearms or weapons in the home. There is a fireplace in the home, located in the on-limits living room which is secured with a front gate covering. There is a body of water on the premises, a jacuzzi hot tub located in the backyard area. LPA confirmed that the jacuzzi is secured with a weight bearing cover that is securely latched down. The jacuzzi area is secured from the outdoor play area with a gate and child proff carabinier lock. The applicant stated that children will pass through this area when entering the facility and confirmed that the only times that children will be in proximity of the jacuzzi is when they are being escorted to and from the facility by their parent / guardian. LPA advised the applicant to be cautious and observant of this area to ensure the gate remains closed and the jacuzzi cover remains securely latched down at all times.

LPA observed that all toxic cleaning supplies or items that pose a danger to children are stored in secure and inaccessible locations. The indoor activity areas were observed to be organized and the applicant has age appropriate toys and supplies. The applicant stated that children will nap in the bedrooms and LPA observed an adequate amount of furniture and items for napping, including furniture, pillows and blankets. The applicant stated that she understands that she would be required to have age appropriate equipment for infants should they need it. The applicant stated that she understands which items are required to be posted during facility operation. The applicant understands that there should be at least 72 hours worth of water, non-perishable foods, and other essential items in the event of an emergency.

The applicant does not intend on assisting children with medications at this time. The applicant has been informed that any time assistance with medication is provided the facility is required to have an Incidental Medical Services (IMS) Plan. LPA and the applicant discussed the facility IMS Plan in detail. LPA provided the applicant with IMS resources to produce an IMS plan if needed.

The applicant stated that she will not be providing transportation or field trips at this time and understands the following: written approval shall be obtained from parents if transportation is provided, children may not be left alone and shall be supervised at all times when being transported, seat belt and car seat laws must be obeyed at all times, and the applicant is responsible for ensuring that the vehicle used to transport children is safe and maintained regularly.

LPA and the applicant discussed capacity options and the applicant understands the terms of the Family Home Child Care license are as follows:
MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 05/07/2019):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: MAZLOOM, SEDIQUE	FACILITY NUMBER: 444415860
	VISIT DATE: 05/07/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #3 - REPORT DATED 05/07/2019):

The applicant has been informed that upon arrival children must be removed from car seats, that bouncers are prohibited from Family Home Day Cares, and that children may not be held in high chairs when not feeding or preparing for feeding time. LPA and the applicant discussed the Community Care Licensing Division website and discussed access to general updates, changes to Title 22 regulations, health and safety codes, the role of the Licensing Program Analyst (LPA) and other ongoing licensee requirements and responsibilities. LPA advised that licensing forms and all other information can be found at: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

LPA advised the Applicant of the required Immunizations (MMR, Tdap, Influenza *Optional) for all individuals who provide care and supervision to day care children and the "Mandated Reporter" training that all staff will be required to complete starting January 1, 2018. LPA referred the Applicant to the Department website to access the training:
https://mandatedreporterca.com/

Based on today's inspection, the facility physical plant has been APPROVED for licensure pending Community Care Licensing management approval.

Exit interview conducted with Ms. Sedique Mazloom, Licensee Applicant.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019

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: MAZLOOM, SEDIQUE	FACILITY NUMBER: 444415860
	VISIT DATE: 05/07/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 05/07/2019):

The applicant stated she will be using talking and redirection as forms of discipline. LPA informed the applicant that time out can only be used one minute per year of age. The applicant stated she understands that children's personal rights should not be violated; including no corporal punishment. LPA and the applicant discussed isolation of sick children, supervision of children, requirements for reporting suspected child abuse, unusual incident/injury reporting, heat related illnesses and weather conditions, requirements for assistant/substitute, and immunization requirements for staff including the new regulation regarding Pertussis, Measles, and Influenza. LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months, must be documented, and must be available for review by the department. LPA discussed the requirements of AB 633, recent updates to the car seat law, healthy beverages in child care, and safe sleep for infants.

LPA and the applicant discussed emergency disaster procedures including supplies in the home, lock down procedures, as well as protocols and supplies in the event of having to leave the facility. LPA and the applicant discussed methods of payment of licensing fees and updating facility information.

A review of records during today's inspection indicates that individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also 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.

Incidental Medical Services (IMS) policy was discussed. 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

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #4 - REPORT DATED 05/07/2019):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019

LIC809 (FAS) - (06/04)

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