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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700150
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:26:44 AM

Document Has Been Signed on 09/08/2022 11:26 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SHAHID, FOUZIAFACILITY NUMBER:
015700150
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Fouzia ShahidTIME COMPLETED:
11:30 AM
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On 09/08/2022, Licensing Program Analyst (LPA) Melanie Otsuji, met with licensee Fouzia Shahid for an UNANNOUNCED 1 YEAR REQUIRED INSPECTION and to conduct a CAPACITY CHANGE INSPECTION. Also present during inspection was Licensee's child, fingerprint cleared spouse and 4 children (3 preschoolers and 1 infant). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 6:45am until 5:30pm.

The ON LIMIT AREAS are the great room, bedroom #1, bathroom off of the great room and front and back (which includes the lunch area) yards The OFF LIMIT AREAS are the master bedroom, bedroom #2, kitchen/dining area and the garage The ISOLATION AREA will be the outside bench area. There are toys and learning equipment. There are no pools, hot tubs or any other bodies of water present in the on limit areas during the time of the inspection. The home has a fully charged fire extinguisher. All hazardous materials and toxins are kept out of the reach of children. Facility has a working smoke detector and working carbon monoxide detector, and working telephone. Facility last conducted a disaster drill in August 2022. Per licensee, there are no firearms in the home. All REQUIRED forms are posted and visible for public review.

LPA received an approved fire clearance from the Fremont Fire Department with an inspection approval date of June 6, 2022.

Incidental Medical Services (IMS) policy was discussed. 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
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: SHAHID, FOUZIA
FACILITY NUMBER: 015700150
VISIT DATE: 09/08/2022
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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.

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.

No deficiencies noted on today's date. A notice of site visit was given and must remain posted for 30 days.

A license for the increase in capacity will be issued effective today, 9/8/2022.

Exit interview conducted and report was reviewed with the licensee Fouzia Shahid.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
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