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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423485
Report Date: 11/06/2024
Date Signed: 11/06/2024 02:27:43 PM

Document Has Been Signed on 11/06/2024 02:27 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:IRFAN, ASMAFACILITY NUMBER:
013423485
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
11/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Asma IrfanTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 11/6/2024 at 1:10PM Licensing Program Analyst (LPA) Jaleesa Jackson met with Licensee Asma Irfan for an Unannounced Licensee Initiated Case Management Visit. Licensee requested increasing capacity of her Family Child Care License (FCCH) from 8 to 14 children. Present during the inspection was the Licensee, her fingerprint cleared assistant, 2 infants and 1 preschool aged child. Licensee lives in the home with her husband and 2 minor daughters. Licensee’s home was toured for a health and safety inspection.

ON LIMITS AREA: Living Room, Family Room, Bathroom #1(Hallway Bathroom), Bedroom #1 (first room on the right of hallway), Kitchen, Dining Area, and Left Side of the Backyard



OFF LIMITS AREA: Master Bedroom and Bathroom, Bedroom #2 (end of hallway), Bedroom #3(end of hallway), Bathroom #2 (inside Bedroom #1), Right Side of Backyard and Garage

ISOLATION AREA: Living Room

The home has gained a fire clearance on 10/21/2024 from the City of Fremont Fire Department with the condition of the garage not to be used for childcare.

The facility is a single-story home owned by the Licensee. The inside of the home was observed to have age-appropriate materials for the children. During today's inspection 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.

Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: IRFAN, ASMA
FACILITY NUMBER: 013423485
VISIT DATE: 11/06/2024
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The home has a fully charged fire extinguisher in the kitchen. There are working carbon monoxide detector and smoke alarm in the home. 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 children in care.

Licensee’s Health and Safety training has been completed and Pediatric CPR and First Aid training is complete and expires on 8/2025. Licensee’s Mandated Reporter training is complete and expires 8/5/2025. LPA reviewed ratios for a large Family Child Care Home with the Licensee. The Licensee understands when no assistant provider is present the Family Child Care Home must operate as a small license.

The Family Child Care Home Increase of capacity has been approved on 11/06/2024.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
LIC809 (FAS) - (06/04)
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