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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422998
Report Date: 03/10/2022
Date Signed: 03/10/2022 02:58:21 PM

Document Has Been Signed on 03/10/2022 02:58 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:ABDO, PHALESTINAH & QAYUM, HALIMFACILITY NUMBER:
013422998
ADMINISTRATOR:ABDO, PHALESTINAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 515-0500
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Phalastinah AbdoTIME COMPLETED:
03:05 PM
NARRATIVE
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On March 10, 2022 at approximately 10:30am Licensing Program Analyst (LPA) Haderer met with the licensee Phalastinah Abdo for the purpose of conducting an unannounced 1-year annual inspection for Health and Safety compliance. Present for today’s inspection was the licensee, her fingerprint cleared assistant and 8 children in care (ages 3 to 5 years old). Hours of operation are Monday -Thursday 8:00am 3:30pm.

The facility is a single-story home with 3 bedrooms, 2 bathrooms, a large living room (two joined rooms), kitchen, family room, and an attached 2-car garage, front, back and side yards. There is a fireplace in the off-limits family room that is blocked by an air conditioner unit, licensee does not use the fireplace. The home has heating and ventilation for safety and comfort. Per the licensee, the ISOLATION AREA will be in the on-limits living room in a corner away from the other children in care.

ON LIMIT AREAS: Large double-room living room; house bathroom, short hallway to the bathroom; entire backyard. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products.



OFF LIMIT AREAS: All 3 bedrooms in the home, kitchen, family room and attached 2-car garage. The off-limit areas will be inaccessible by child gates, closed and/or locked doors and adult supervision.

The home has a fully charged 3A40BC fire extinguisher in the living room, smoke detectors and carbon monoxide detector (all tested and working) and a working telephone. Fire drills are conducted every 6 months, the last drill was completed on 1-19-2022. Parent's Rights was not posted in a prominent, public accessible area. (See LIC809D). Licensee has ample age-appropriate toys and learning materials inside and outside the home. Per licensee, there are no firearms in the home. Drop-down cribs are not allowed at the day-care facility. Toxins, medicines, and hazardous items were inaccessible during today's inspection.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ABDO, PHALESTINAH & QAYUM, HALIM
FACILITY NUMBER: 013422998
VISIT DATE: 03/10/2022
NARRATIVE
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There is a large wooden play structure in the backyard with a slide, swings and monkey bars. The structure is free from hazards. The soft materials under the monkey bars portion has rubber mats underneath to protect children should they fall. There is a new trampoline that will be allowed for children’s use provided the manufacture’s safety requirements are followed and there is only one child using it at one time and adult supervision is always present. There is also a balance beam that can only be used by one child at a time and allowed as long as there are rubber mats on both sides of the beam and child supervision is present at all times.

At 11:40am, LPA reviewed facility files and the Children’s files. Complete files were not kept for the licensee nor assistant, (See LIC809D). Copies of some immunization records were in the CCLD office files (licensee and assistant: MMR and tdap). Proof of TB was available for licensee but not assistant (See LIC809D). CPR / 1st Aid was available for licensee, expires 11-20-2023, assistant expires on 1-2-2024. Mandated Reporter has expired for both Licensee and assistant. ((See LIC809D). Licensee was reminded that CPR/1st Aide and Mandated Reporter is to be renewed every two years.

Children’s files were complete and well organized. The facility roster was reviewed, and a copy obtained. The licensee rents the property, and carries liability insurance through Progressive.

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

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

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ABDO, PHALESTINAH & QAYUM, HALIM
FACILITY NUMBER: 013422998
VISIT DATE: 03/10/2022
NARRATIVE
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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 4 deficiencies issued today. See LIC809D for details. The 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 Phalastinah Abdo.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 03/10/2022 02:58 PM - It Cannot Be Edited


Created By: Russell Haderer On 03/10/2022 at 02:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ABDO, PHALESTINAH & QAYUM, HALIM
FACILITY NUMBER: 013422998

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Mandated Reported expired for both the Licensee and assistant which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/17/2022
Plan of Correction
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Licensee and assistant both shall complete Mandated Reporter training (Child Care Provider AB1207) and provide a copy of the completion certificate to LPA. www.mandatedreporterca.com
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that proof of TB clearance was not available for assistant which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/08/2022
Plan of Correction
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Assistant will located proof of TB clearance or re-take a new TB test. Licensee will provide a copy to LPA as proof of completion and keep a record of the TB result in assistant's personnel file.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/10/2022 02:58 PM - It Cannot Be Edited


Created By: Russell Haderer On 03/10/2022 at 02:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ABDO, PHALESTINAH & QAYUM, HALIM
FACILITY NUMBER: 013422998

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that there was no personnel file for assistant with any of the required documents (LIC501 Personnel Record; LIC 508 Criminal Record Statement; LIC 9052 Personal Rights, etc.) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/17/2022
Plan of Correction
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Assistant will complete all records noted above and supply to Licensee. Licensee will create a personnel file to maintain all records of these items, as well as immunization records, Mandated Reporter and CPR/1st Aide certificates.
Type B
Section Cited
CCR
102419(b)
Admission Procedures and Authorized Representatives Rights
(b) The licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that no Parents' Rights poster was placed in a prominent and publicly accessible area which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2022
Plan of Correction
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LPA printed a poster, Licensee posted the Parent's Rights poster the same day.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022


LIC809 (FAS) - (06/04)
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