013422627-4-21-2023-52-CC-RHAR-CR4QY2-20230421123424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422627
Report Date: 04/21/2023
Date Signed: 04/21/2023 12:34:32 PM

Document Has Been Signed on 04/21/2023 12:34 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	JABEEN, ZAHIDA		FACILITY NUMBER:	013422627
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 5	CENSUS: 5	DATE:	04/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Zahida Jabeen		TIME COMPLETED:	12:45 PM

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On April 21, 2023 at approximately 10:45am 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, adult daughter and 16-year-old son. Present in the home today is the licensee, Jasbir Kaur (assistant to cook and clean), licensee’s husband, adult daughter; 16-year-old son and 5 children in care (2 infants; 3 two years old). 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-limit-areas include: Living room; 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: 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.

The home has a fully charged 2A10BC 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 on-limits living room with a zip-tied glass screen. Fire and earthquake drills are conducted a minimum of every 6 months, the last drill was completed on 12-15-2022.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: JABEEN, ZAHIDA	FACILITY NUMBER: 013422627
	VISIT DATE: 04/21/2023

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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.

LPA reminded licensee of the following: CPR/1st Aid and Mandated Reporter training must be 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.

Children's files were reviewed, a roster was reviewed and a copy taken by the LPA. All files were complete and in good order. Sleep logs were present for infants, reviewed and complete. The licensee 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

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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: JABEEN, ZAHIDA	FACILITY NUMBER: 013422627
	VISIT DATE: 04/21/2023

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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: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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