013423592-5-3-2022-02-CC-PDYR-CE3UPM-20220503154542

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423592
Report Date: 04/29/2022
Date Signed: 05/03/2022 03:45:54 PM

Document Has Been Signed on 05/03/2022 03:45 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-RAHMAAN		FACILITY NUMBER:	013423592
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	04/29/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Abdul-Rahmaan Karim		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	LPA L. Dyer met with licensee Abdul-Rahmaan Karim for an unannounced Annual (Required) Increase in Capacity inspection. Licensee was present with 5 children (2 infants and 3 preschoolers) . LPA toured the facility for a health and safety inspection. The home was equipped with a fully charged 3-A:40-B:C fire extinguisher, a working smoke detector (tested), a carbon monoxide detector and a first aid kit. Fire safety inspection by the Oakland Fire Department was approved with Code 1 - Fire Clearance granted 4/13/22. Per the fire marshal's instructions, licensee has installed a pull fire alarm system and blocked the water heater. Licensee had files for all children in care. He declined to review forms. Stairs are gated. There was a working telephone. The licensee stated there were no firearms or bodies of water on the premises. There were a variety of books and toys for children's use. Licensee has a bearded dragon as a pet. Backyard was inspected at 1:23 p.m. Backyard has a shaded area. Licensee has a swing, riding toys, a slide, and trampoline in the backyard. Licensee was reminded to follow all rules for the trampoline that are posted on the apparatus. A sample of these items are: 1. Don't allow access under the trampoline. 2. Allow one person at a time on the trampoline. 3. Trampoline use is not recommended for children under the age of six. 4. There should always be a spotter watching the person in the trampoline. The last disaster drill logged was 4/29/22. All adults present during this inspection were fingerprint cleared and associated to the facility. Licensee's fees are current. Pediatric First aid and CPR cards expire on 7/3/2022. LIcensee's Mandated Reporter Training expires 6/22/22. Licensee's immunization records have been reviewed. All licensing-required documents are posted. This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: (continued)

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KARIM, ABDUL-RAHMAAN	FACILITY NUMBER: 013423592
	VISIT DATE: 04/29/2022

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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 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; and to notify the department IN WRITING if he decides to move or discontinue the license. Zero Tolerance Regulations were also discussed. Licensing regulations, updates and forms can be obtained from our website: www.ccld.ca.gov.

A QUALIFIED ASSISTANT MUST BE PHYSICALLY PRESENT AND INVOLVED IN CARING FOR CHILDREN WHENEVER 9 OR MORE CHILDREN ARE PRESENT AT A LARGE FCCH. WHEN AN ASSISTANT IS NOT PRESENT, THE HOME REVERTS BACK TO SMALL FAMILY CHILD CARE RATIOS.

GARAGE AREA IS OFF LIMITS TO DAY CARE CHILDREN.

License for Increase In Capacity is recommended as of today, 4/29/22, pending receipt of all final clearances and the completion of all requirements. A license will be processed as soon as administratively possible.

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.

For CCL Updates, go to www.ccld.ca.gov. Click the "Receive Important Updates" box. Enter your e-mail address.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC809 (FAS) - (06/04)

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