566215915-7-9-2021-17-CC-FPEA-C4RNWH-20210709104933

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215915
Report Date: 07/09/2021
Date Signed: 07/09/2021 10:49:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	FAROOK FCC AKA SAFIA'S HOME DAYCARE		FACILITY NUMBER:	566215915
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	07/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Fathima Farook		TIME COMPLETED:	10:15 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	On July 9, 2021 at 9:19 am, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with Licensee Fathima Farook and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There was three (3) children in care at the time of the inspection. The licensee is currently using the living room, dining room, one bathroom, and backyard for children in care. Licensee has two gates preventing children from having access to the kitchen. LPA did not observe any toxin/hazards accessible to children in care. Licensee has the disinfectants on the top shelf in secured closet. LPA observed a 2A10BC fire extinguisher with a purchase date of 5/21/21 in the same closet with the disinfectants readily accessible. Licensee advised to ensure the fire extinguisher is serviced or a new one in purchased every year. LPA observed a fireplace in the living room with a pad blocking the opening and a sofa preventing children from having access. The facility has working smoke and carbon monoxide detectors. LPA observed age appropriate toys and furniture readily accessible to children in care. The backyard is enclosed by a concrete wall with two wood fences on each side of the home. LPA observed age appropriate toys and structures in the backyard readily accessible to children in care. LPA observed there was an ample amount of shade for children. Licensee advised there are no firearms or live ammunition in the home. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FAROOK FCC AKA SAFIA'S HOME DAYCARE	FACILITY NUMBER: 566215915
	VISIT DATE: 07/09/2021

NARRATIVE

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LPA observed the facility roster and identified that it was current. A sampling of children records were reviewed and found to be current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Currently the licensee does not have liability insurance and has signed waivers in each child's file that was reviewed. Licensee's Pediatric CPR/First-Aid certificate is current and valid until 4/21/2023. Licensee's Mandated Reporter certificate is current and valid until 4/25/2023. The last fire drill was completed on 6/29/2021. Licensee reminded to ensure the fire/emergency drills are logged and completed once every six (6) months. LPA discussed current Safe Sleep and Covid-19 requirements with licensee.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

No deficiencies were cited during today's inspection.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

LIC809 (FAS) - (06/04)

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