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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423683
Report Date: 11/06/2024
Date Signed: 11/06/2024 10:39:58 AM

Document Has Been Signed on 11/06/2024 10:39 AM - 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MOMIN, BEBIAYESHAFACILITY NUMBER:
013423683
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
11/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Bebiayesha MominTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On 11/6/24 at 9:30 AM, Licensing Program Analysts (LPAs) Joe Mary Vargas and Christina Watts conducted an unannounced Case Management - Licensee Initiated for Bebiayesha Momin small family child care. The licensee requested for the backyard to be placed on limits. LPAs met with the licensee and explained the purpose of this visit. During today's visit, there were 4 preschool children in care. The licensee stated that 5 children were enrolled. The facility's hours of operation are 8:30 AM to 6:00 PM.

The Licensee wanted to add the backyard as an additional area to supervise and care for children. During today's inspection, the LPAs conducted a health and safety inspection for the backyard. The backyard has a secure outdoor area with an on-ground deck and a play area with wood chips. The backyard has a new fence and railings. There is a play structures and swings which is safe for childcare use. LPAs reminded the licensee to make gate keys inaccessible to children to prevent accessibility to off-limit areas.

Prior to having the backyard approved as an ON-LIMIT area licensee will submit the following corrections:

ยท Area behind the garage should be made inaccessible to children.

Licensee agrees to have all corrections made by 11/20/24. Licensee understand that she needs to submit the plan of correction prior to on limit use.

An exit interview conducted and report was reviewed with the licensee, Babiayesha Momin. A notice of site visit was given and must remain posted for 30 consecutive days
Monica MathurTELEPHONE: (510) 421-3522
Joe Mary VargasTELEPHONE: (510) 368-5196
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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