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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422627
Report Date: 03/12/2024
Date Signed: 03/12/2024 12:33:49 PM

Document Has Been Signed on 03/12/2024 12:33 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, ZAHIDAFACILITY NUMBER:
013422627
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
03/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:47 AM
MET WITH:Zahida JabeenTIME COMPLETED:
03:02 PM
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Licensing Program Analyst Sidney Cortez provided technical assistance to the licensee who plans to have a capacity increase for her facility. Fire Clearance stil pending. Licensee wanted to go over ratios, and the forms; and the physical plant changes.

Present for this visit was the licensee, and 3 pre school age children). The facility currently operates from 7:00AM until 7:00 PM, MONDAY-FRIDAY.


The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. The areas used for childcare (ON LIMITS) are the living room, dining/family room, kitchen, two bedrooms to the right in hallway, bathroom and the backyard. Licensee has installed child safety gates at entrance to kitchen, and between living room and dining rooms. The main children's area is the dining/family room. The outdoor play area is a deck that has fencing surrounding it, and is free from defects and dangerous conditions. The OFF LIMIT areas are the master bedroom, garage and the area outside of the fenced backyard deck. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

The home has a fully charged 2A10BC fire extinguisher, working carbon monoxide and smoke detectors, telephone, and first aid kit. The licensee's Pediatric CPR/First Aid certificate is current and expires Jan 2025. The fireplace is screened and has a child safety lock. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted Jan 2024. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. All required licensing documents are posted and visible for public review.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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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