<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415860
Report Date: 06/19/2019
Date Signed: 06/19/2019 10:38:46 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, SEDIQUEFACILITY NUMBER:
444415860
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
06/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sedique Mazloom TIME COMPLETED:
11:00 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 Unannounced Case Management - Other Inspection at the facility today. Upon arrival, LPA observed four (4) infants in care and met with Ms. Sedique Mazloom, Licensee. The Licensee, her spouse, and one minor child are the only individuals that reside in the home and all adults maintain valid fingerprint clearance. The Licensee was licensed to operate from this location on 05/21/19 and has experience being previously licensed at another location for approximately 5 years. The Licensee is currently applying for a capacity increase to serve a maximum of 14 children as a Large Family Child Care Home. Days and Hours of operation are Monday through Friday 8:00am to 5:30pm. The Licensee 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. LPA toured the home inside and out and observed during the inspection that the Licensee has all required postings, a roster of all children enrolled, and complete children's files. During the inspection the Licensee has been given additional information on Active Shooter response, the Effects of Lead on children and families, and Infant Safe Sleep Environments.

The Licensee has been granted an approved Fire Clearance from the local fire authority dated 06/11/2019. Areas of the home not approved for day care operation include the entire upstairs portion of the home, the garage, and the storage shed. The garage is not detached from the home and is not approved for day care use. The Licensee understands the terms of a Large Family Child Care Home License which are as follows:

MAXIMUM CAPACITY (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAPACITY 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

Based on today's inspection, the facility physical plant has been APPROVED and final licensure for the capacity increase shall be granted pending Community Care Licensing Management approval. A Notice of Site Visit has been issued and must remain posted for 30 consecutive days. No Deficiencies have been cited today. Exit interview conducted with Ms. Sedique Mazloom.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
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 1