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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422837
Report Date: 07/17/2024
Date Signed: 07/17/2024 03:02:57 PM

Document Has Been Signed on 07/17/2024 03:02 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:MOHAMMED, SHAHEENFACILITY NUMBER:
013422837
ADMINISTRATOR/
DIRECTOR:		MOHAMMED, SHAHEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 515-0419
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Licensee Shaheen MohammedTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee, Shaheen Mohammed for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was Licensee and helper supervising three (3)infants and six (6) preschoolers. Licensee lives in the house with her husband and two children. The home is a two-story home with four bedrooms, 2.5 bathrooms, a living room, kitchen, dining area, laundry room, garage, and back yard. The hours of operation are 9:00am to 5:30pm, Monday -Friday.

On limit area: a living room (main day care area), kitchen, dining area, half bathroom on the first level,and backyard.Off-limit-areas: the entire second floor, and garage. All off limit areas are inaccessible by closed and/or locked doors and visual supervision.

LPA inspected the house for health and safety hazards.Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water in the day care area during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. The napping cots in good condition and each child have their separate blankets and sheets. Per licensee, parents wash the bedding weekly. There is a child safety gate located at the bottom of the stairs to prevent access to the stairs and upper levels to children in care. Licensee states there are no guns or weapons of any kind in the home. There are no pets in the home. Licensee’s CPR expire on 05/2025. Licensee provides lunch and children are require to bring own snacks. LPA reviewed children’s files. All the files are complete and up to date. All required postings are properly posted. LPA discussed safe sleep guidelines and reminded to document 15 minutes sleep check. Licensee's assistant is exempt from taking mandated reporting training until it is offered in her primary language. The fire drill log indicates that the last drill was conducted on 06/18/2024.


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SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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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: MOHAMMED, SHAHEEN
FACILITY NUMBER: 013422837
VISIT DATE: 07/17/2024
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During Inspection, 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.

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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

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.

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

There is no deficiency cited today however one technical Violation was given.

Exit interview conducted and report was reviewed with the licensee, Shaheen Mohammed

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024
LIC809 (FAS) - (06/04)
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