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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423878
Report Date: 06/14/2023
Date Signed: 06/14/2023 02:26:47 PM

Document Has Been Signed on 06/14/2023 02:26 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:SHUAIBE, HANEEFAHFACILITY NUMBER:
013423878
ADMINISTRATOR:HANEEFAH SHUAIBEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 381-4242
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/14/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Haneefah ShuaibeTIME COMPLETED:
03:45 PM
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On 06/14/2023 at 1:30 PM Licensing Program Analyst (LPA), A. Curry arrived at the home and conducted an announced Prelicensing inspection. LPA met with applicant, Haneefah Shuaibe, who submitted an application for a Large Family Child Care Home. The hours of operation for the family child care home will be Monday-Saturday 6:00am-8:00pm. A tour of the home was completed with the applicant to conduct a health and safety inspection.

The home is two stories and consist of 4 bedrooms, 3 bathrooms, living room, dining room, kitchen, nook, storage room, fenced backyard, and front yard. The children will use the two downstairs bathrooms, combined living room and dining room, kitchen, nook, and backyard. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. The off-limits areas are the downstairs storage room and entire upstairs, which consist of 4 bedrooms and 1 bathroom. The off-limit areas will be inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be the nook. The applicant was advised that any area that will be changed to an on limit area will need to be inspected by Licensing prior to use. There were safe toys, play equipment, and materials observed for children. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children. The applicant was advised that all poisons and/or hazardous items must be kept in a locked cabinet/drawer or placed out of reach of children. The stairs that lead to the upper part of the home is made inaccessible by a closed door. The applicant stated\s there are no firearms on the premises.



The home is equipped with a fully charged 2A10BC fire extinguisher, working smoke alarm, working carbon monoxide detector, telephone, and first aid supplies. The applicant completed the required preventative health and safety training, which includes 1 hour of nutrition, the required lead poisoning prevention training, and has current CPR and First Aid training which expires on April 24, 2025 respectively.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2023
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: SHUAIBE, HANEEFAH
FACILITY NUMBER: 013423878
VISIT DATE: 06/14/2023
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LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA advised the applicant that the postings need to be in a place that is visible and accessible to the public. LPA reviewed the ratio and capacity of a small and large family child care home license.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The applicant is reminded of the following: to review and follow COVID-19 guidelines and to report any injuries or unusual incidents. The applicant is advised to review licensing regulations and guidelines, including the Provider Information Notices (PINs) on the website www.ccld.ca.gov and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. When any IMS is provided, 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, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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: SHUAIBE, HANEEFAH
FACILITY NUMBER: 013423878
VISIT DATE: 06/14/2023
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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/process.

This home will be effective today 06/14/2023. Exit interview conducted, appeal rights were given, and report was reviewed with the applicant Haneefah Shuaibe.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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