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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008496
Report Date: 02/10/2020
Date Signed: 02/10/2020 02:20:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:HANIF, JAMEELAH FCCHFACILITY NUMBER:
483008496
ADMINISTRATOR:HANIF, JAMEELAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 394-7200
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:14CENSUS: 4DATE:
02/10/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Jameelah HanifTIME COMPLETED:
02:30 PM
NARRATIVE
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A Required inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. A review of staff records on 02/10/20 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There is currently one adult living in the home.

During today’s inspection the home and grounds were toured. The licensee was supervising four children, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 4:00am to 3:00am, Sat–Sun. The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home are three bedrooms, kitchen and patio balcony, and were made inaccessible by children's safety gates and door locking mechanism. The home was observed to be clean and orderly, and was at a comfortable indoor temperature of 77 degrees Fahrenheit. There were safe toys and equipment available for children. The licensee stated there is a working telephone in the home. At 12:50pm, LPA requested the licensee’s pediatric CPR and First Aid certifications, however, the Licensee stated that her Pediatric CPR and First Aid certification were expired. Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children. Poisons were locked in an off limits bedroom. The LPA observed a working smoke detector, carbon monoxide detector and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months, last drill was documented on 01/06/20. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The patio balcony is currently off limits. The children use the local community park as the outdoor play area. There were no pools or other bodies of water observed. Two children's (C1 and C2) records were reviewed at 1:07pm; Notification of Parent’s Rights forms were on file for C1 and C2, however, C1's immunization record is not up to date. LPA issued an Advisory Note for this Technical Violation.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020
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 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,
, CA
FACILITY NAME: HANIF, JAMEELAH FCCH
FACILITY NUMBER: 483008496
VISIT DATE: 02/10/2020
NARRATIVE
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The licensee is not providing Incidental Medical Services (IMS) to children in care. The Incidental Medical Services (IMS) policy was discussed with the licensee. 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 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, www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2020
LIC809 (FAS) - (06/04)
Page: 2 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,
, CA

FACILITY NAME: HANIF, JAMEELAH FCCH
FACILITY NUMBER: 483008496
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2020
Section Cited

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The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by: Based on the Licensee's furnishing a current and valid CPR and First Aid certification to LPA
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 at 12:50pm. This poses a potential health, safety or personal rights risk to the children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Public Email: cclrpregionalofficegeneral@dss.ca.gov

Fax: 707-588-5099

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3