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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700391
Report Date: 10/19/2023
Date Signed: 10/19/2023 01:59:56 PM

Document Has Been Signed on 10/19/2023 01:59 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HUSEIN, LINAFACILITY NUMBER:
015700391
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:42 PM
MET WITH:Lina HuseinTIME COMPLETED:
03:02 PM
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Licensing Program Analyst Sidney Cortez, met with licensee Lina Husein , for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee Lina Husein, and her , fingerprint cleared staff member Rukhshana Momand, 1 infant, 4 school age children (5 total children)

The home was inspected to conduct a Health and Safety Inspection. The facility currently operates from 6:00AM until 6:00 PM, MONDAY-SUNDAY.

The home consists of 4 bedroom, 3 bathroom, living room/play room area, dining room, kitchen, backyard and garage.
The OFF LIMIT AREAS is the 1 master bedroom, 2 bathroom, and part of the kitchen and portion of the backyard/patio. The ON LIMIT AREAS are the living room, family room, 3 bedrooms, 1 bathroom, portion of the backyard and garage . The ISOLATION AREA is one of the on limit bedroom

There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children.
There are age appropriate toys, furniture and equipment.. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Per licensee, there are no firearms in the home.

The licensee’s Health and Safety training is completed and CPR and First Aid certificates are current and expires NOV 2024.

The licensee's mandated reporter training is current and expires (MARCH, 2025). The licensee conducts and documents fire and disaster drills twice a year with the last one conducted in AUG 2023.
2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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