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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423485
Report Date: 07/31/2023
Date Signed: 07/31/2023 03:52:49 PM

Document Has Been Signed on 07/31/2023 03:52 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:IRFAN, ASMAFACILITY NUMBER:
013423485
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
07/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:33 PM
MET WITH:Asma IrfanTIME COMPLETED:
03:50 PM
NARRATIVE
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On 7/31/2023 at 12:33pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Asma Irfan for a Required – 1 Year Inspection. Present during the inspection was the Licensee, her helper Ayesha Maveed, three (3) infants and two (2) preschool age children. Licensee lives in the home with her husband, Irfan Malik, their adult daughter, Sara Malik and two other minor children, age eleven (11) and sixteen (16). Licensee’s three daughters were present during LPA’s inspection but remained in off limit areas. The facility operates 7:00am – 6:00pm, Monday – Friday.

ON LIMITS AREA: Living Room, Family Room, Hallway Bathroom, 1st Bedroom on the Right, Kitchen, Dining Area, and Left Side of the Backyard
OFF LIMITS AREA: Master Bedroom and Bathroom, Two (2) Bedrooms, 2nd Hallway Bathroom, Right Side of Backyard and Garage
ISOLATION AREA: Living Room

The facility is a single-story home owned by the Licensee. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee stated that she provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. All off limit areas are made inaccessible with gates, locks, and closed doors. Licensee stated she does not transport children. There are no pets and no firearms in the home.

There is one (1) fully charged 2A10BC fire extinguisher on the wall next to the refrigerator. There is one (1) working smoke/carbon monoxide detector in the hallway and in the on-limit bedroom. The home is equipped with central heat and air for proper ventilation. The fireplace in the family room is blocked by furniture making it inaccessible to the children in care.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
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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Document Has Been Signed on 07/31/2023 03:52 PM - It Cannot Be Edited


Created By: Morgan Pringle On 07/31/2023 at 02:12 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: IRFAN, ASMA
FACILITY NUMBER: 013423485

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:

(1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based oninterview and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2023
Plan of Correction
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Licensee will ensure that Helper Ayesha Maveed obtains a criminal record clearance before returning to the facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/31/2023 03:52 PM - It Cannot Be Edited


Created By: Morgan Pringle On 07/31/2023 at 02:18 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: IRFAN, ASMA
FACILITY NUMBER: 013423485

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2023

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/03/2023
Plan of Correction
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Licensee will renew her Mandated Reporter certificate and send LPA Pringle proof of completeion by POC date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/03/2023
Plan of Correction
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Licensee will renew Pediatric CPR & First Aid training by POC date and send LPA proof of correction If renewal cannot be obtained by POC date, Licensee is to register for a training and send LPA Pringle proof of registration by POC date.
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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2023


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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: IRFAN, ASMA
FACILITY NUMBER: 013423485
VISIT DATE: 07/31/2023
NARRATIVE
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All cribs, play yards and napping equipment are free from defects and in good condition. The backyard is fully fenced with ample age-appropriate materials for the children. The right side is gated making it inaccessible. There is a storage shed on the right side making it inaccessible as well.

Licensee’s Health and Safety training has been completed. Licensee’s Pediatric CPR & First Aide as well as Mandated Reporter training are expired as of June 2023 (See LIC809D). LPA informed Licensee that she was to make sure both training's were completed before she left for vacation in June. All required forms are posted and visible for public view in the living room. Fire/Disaster drills have been completed with the last drill logged 4/14/2023. All adults living in the home have obtained a criminal record clearance. During LPA’s inspection it was found that Licensee’s helper Ayesha Maveed did not have a criminal record clearance. Licensee stated that she is “trying her out to see if she wants to hire her.” Licensee stated that this is Maveed’s first day. LPA informed Licensee that all adults need to have a clearance prior to their initial day at the facility and cannot return to the facility until clearance is obtained (See LIC809D). LPA obtained a sample of the children’s files, the facility files and facility roster. Through record review it was found that one (1) infant present did not have a file. Licensee stated it was the child's first day and the infant is the younger sibling to another child present. Licensee also did not have any documentation for her helper.

Deficiencies Cited During LPA’s Inspection
· Expired Mandated Reporter training
· Expired Pediatric CPR & First Aid training
· Helper present in home without a criminal record clearance

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or email. Licensee was reminded that any structural changes or additions to the home must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: IRFAN, ASMA
FACILITY NUMBER: 013423485
VISIT DATE: 07/31/2023
NARRATIVE
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Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting https://mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Asma Irfan, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: IRFAN, ASMA
FACILITY NUMBER: 013423485
VISIT DATE: 07/31/2023
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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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

LPA Morgan Pringle informed licensee Asma Irfan that this report dated 7/31/2023 document(s) one (1) Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Pringle informed the licensee to provide a copy of this licensing report dated 7/31/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Asma Irfan.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
LIC809 (FAS) - (06/04)
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