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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423592
Report Date: 08/11/2021
Date Signed: 08/11/2021 12:22:25 PM

Document Has Been Signed on 08/11/2021 12:22 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:KARIM, ABDUL-RAHMANNFACILITY NUMBER:
013423592
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
08/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Abdul-Rhamann KarimTIME COMPLETED:
12:30 PM
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An unannounced Required - 1 Year inspection was conducted by Licensing Program Analyst L. Dyer. LPA arrived at the facility at 9:45 a.m. The licensee and assistant were present with 4 day care children (1 infant and 3 preschool-age). Facility is in compliance with licensed capacity and facility ratios. All staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Phone number and e-mail address are current.
The day care area of the home was inspected. Areas licensed for child care: living/dining room, 1 bedroom and bathroom. The bedroom has been added. Licensee also has a small garage area. It was specifically discussed that the garage area could not be used as the primary area for the child care. Licensee can use this area as an extension of play or for specialized projects only. Off-limit areas will be made inaccessible to children by closed and/or locked doors; gates; and visual supervision.
The home was clean and orderly, with adequate heating ventilation. There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books and toys for children's use. There was a working smoke detector (tested); a fully charged 3-A:40-B:C fire extinguisher; a first aid kit, and a carbon monoxide detector. There was no fireplace. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are locked, inaccessible to children. Licensee stated there were no firearms or bodies of water on the premises.
Guidance for Child Care Providers and Programs (version June 29, 2021), New Safe Sleep Regulations, and Individual Sleeping Plans for Infants were provided and discussed with the licensee. There are no children under 12 months of age. Bedding is washed weekly.
Back yard area is securely fenced. Licensee has a slide, swings, portable basketball hoop, balls, a trampoline and other outdoor toys for child play. LPA pointed out areas in the backyard where additional care should be taken to watch children. Licensee was requested to place padding/cushioning under the trampoline; and to follow the directions/instructions provide for the Little Tykes trampoline regarding inspection timeline, number of persons in the trampoline, spotters, etc. (continued)
SUPERVISORS NAME: Phyllis Dyer
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: KARIM, ABDUL-RAHMANN
FACILITY NUMBER: 013423592
VISIT DATE: 08/11/2021
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 LPA reviewed facility, personnel and children's records at 10:57 a.m. Mandated Reporter Training and Licensees' CPR/First Aid both expire June 2022. All required forms are posted and visible for public review. Last disaster drill date logged: 5/14/21.
This facility plans to provide Individual Medical Services – IMS. 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 of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary.
Also discussed with the licensee: supervision of children at all times; children are not to be left in parked vehicles; car seats are not to be used for sleeping; substitutes available; advertisements; changes in on-limit areas; construction work at facility; paying fees on-line; smoking; ill children, and the new Guardian background check process. Anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed. Licensee was encouraged to frequently visit the licensing website at www.ccld.ca.govfor licensing regulations, forms and updates.

Important E-mail Addresses:
Community Care Licensing General Information and Updates:www.ccld.ca.gov. For updates, click the "Receive Important Updates" box.
Mandated Reporter Training: www.mandatedreporterca.com
Alameda County Public Health Department Website: www.acphd.org
Guardian: background check process with self-service options: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

NO DEFICIENCIES CITED TODAY.

Exit interview conducted. Appeal rights were discussed and given. Notice of site visit must be posted for 30 days. This report must be available for public review for 3 years.
SUPERVISORS NAME: Phyllis Dyer
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC809 (FAS) - (06/04)
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