013423592-11-30-2023-02-CC-ILOA-CY3W2Y-20231130155509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423592
Report Date: 11/30/2023
Date Signed: 11/30/2023 03:55:15 PM

Document Has Been Signed on 11/30/2023 03:55 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:	KARIM, ABDUL-RAHMAAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 712-2223
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94603
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	11/30/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Karim Abdul-Rahmaan		TIME COMPLETED:	04:05 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	On November 30, 2023 at 1:20pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Karim Abdul-Rahmaan for the purpose of conducting an unannounced 3-year inspection. Present during today's inspection were the Licensee, Domestic Partner/Assistant Alexandra Cuadros, Assistant/sister Nayla Carter and 5 preschool-age children. All adults in the home were fingerprint cleared. The operating days and times are Monday - Friday 6am-7:30pm, and occasionally overnight during the weekends. The home was toured for a health and safety check. The home is a single family house consisting of two bedrooms, one bathroom, kitchen, living room, dining area, garage, and fully fenced in backyard. On Limit Areas - Both bedrooms, living room, dining area, bathroom, and the backyard. Off Limit Areas - The kitchen and garage Isolation Area - The bedroom on the left from the hallway The Licensee stated he would like to set the bedroom on the right from the hallway to "On Limits". LPA inspected the bedroom which was found to be clear of any hazards. The home has a fully charged 3A40BC fire extinguisher, a working combined smoke and carbon monoxide detector next to the ceiling fan, and a working telephone. The home has heating and ventilation for safety and comfort. The Licensee has ample age-appropriate toys and learning materials in the home. The backyard had plenty of activities and equipment to promote gross motor skills. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There were no bodies of water present on the premises. Per the Licensee there are no firearms in the home. LPA reviewed 5 children and 3 staff files. All files were complete. The last fire drill conducted was on August 8, 2023. The Licensee provides all meals to the children in care. The children play in the backyard for outdoor play. ********************************Report Continues on LIC 809-C*****************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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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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: 11/30/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is 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, 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 In a 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.

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.

During the Exit Interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There were no deficiencies issued during today's visit.

Exit interview conducted and report was reviewed with Assistant Alexandra Cuardos.
Report and Appeal Rights were provided.
A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

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