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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422627
Report Date: 04/15/2022
Date Signed: 04/15/2022 03:32:28 PM

Document Has Been Signed on 04/15/2022 03:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:JABEEN, ZAHIDAFACILITY NUMBER:
013422627
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
04/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Zahida JabeenTIME COMPLETED:
03:38 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 April 15, 2022 at approximately 12:50pm Licensing Program Analyst (LPA) Russ Haderer arrived for an unannounced 1-year annual inspection. Living in the home is the licensee, her fingerprint cleared and TB tested husband, two adult daughters and 15-year-old son. Present in the home today is the licensee, her husband, two adult daughters; 15-year-old son and 3 infants in care (one 14 months; one 15 months; one 21 months). The hours of operation are 7:00am to 7:00pm.

The facility is a single story 3-bedroom, 2 bath home rented by the licensee with a living room; dining room; kitchen; family room, attached 2-car garage, side and back yard areas. The outdoor play area is a raised wooden deck surrounded by a fence and is free from defects and dangerous conditions. Per the licensee, there are no firearms in the home. There were ample age appropriate toys observed to be in safe and good condition.

The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the living room, by the front door away from the other children in care.

On and Off limits area revised to remove two bedrooms from on-limits area. All bedrooms in the home will now be off-limits.

On-limit-areas include: Family room (child care room); dining room; house bathroom; hallway leading to the house bathroom; outside raised wooden patio deck. There are child safety gates installed preventing child access to the kitchen and another to separate the dining room from the living room. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area

Off-limit-areas include: Living room; kitchen; all bedrooms in the home; master bathroom; all outside areas except for the raised wooden patio deck; and attached 2-car garage. The off-limit areas will be inaccessible by child gates, closed and/or locked doors, and/or by child supervision.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2022
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 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: JABEEN, ZAHIDA
FACILITY NUMBER: 013422627
VISIT DATE: 04/15/2022
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
26
27
28
29
30
31
32
The licensee CPR and First Aid certificate are current and expire on 6/05/2023; Mandated Reporter has been completed and will expire 6/07/2023. All adults living in the home were in compliance with all immunization laws which pertains to day care providers.

The home has a fully charged 2A40BC fire extinguisher stored on the kitchen counter, a combined smoke alarm and a carbon monoxide detector (all tested and functioning), and a working telephone. There is a fireplace in the off-limits living room with a zip-tied glass screen and blocked by a large sofa. Fire and earthquake drills are conducted a minimum of every 6 months, the last drill was completed on 12-15-2021.

LPA reminded licensee of the following: Mandated Reporter training is to be renewed every two years; CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA did not observe any bodies of water hazardous materials, or toxins accessible to children on the premises during the inspection.

At 1:50pm, children's files were reviewed. The facility roster was reviewed, and a copy obtained. All files were complete and in good order. The licensee rents the property, does not carry liability insurance. All LIC 282 forms Notice of no Liability Insurance signed and dated in each child’s file.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: JABEEN, ZAHIDA
FACILITY NUMBER: 013422627
VISIT DATE: 04/15/2022
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
26
27
28
29
30
31
32
Licensee is aware of the new safe sleep regulations but has not been documenting on the sleep log. All infants are over 12 months and not in cribs, LPA provided sample logs to use going forward.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There were no deficiencies issued today. A copy of this report will remain on file for three years.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Zahida Jabeen.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4