015700391-9-4-2024-52-CC-SCOZ-D8SJYL-20240904072808

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700391
Report Date: 09/04/2024
Date Signed: 09/04/2024 07:28:34 AM

Document Has Been Signed on 09/04/2024 07:28 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	HUSEIN, LINA		FACILITY NUMBER:	015700391
ADMINISTRATOR/ DIRECTOR:	HUSEIN, LINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 571-9839
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	09/04/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Lina Husein		TIME VISIT/ INSPECTION COMPLETED:	12:09 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 2024.
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: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

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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