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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700458
Report Date: 05/03/2023
Date Signed: 05/03/2023 12:21:02 PM

Document Has Been Signed on 05/03/2023 12:21 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:ABDUL RAHIM, AZIZEHFACILITY NUMBER:
015700458
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:TIME COMPLETED:
12:30 PM
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On May 3rd, 2023 at approximately 10:10am, Licensing Program Analyst (LPA) April Wright arrived for Case Management visit and met with Licensee Azizeh Abdul Rahim. Purpose of the visit was for a Change of Location Inspection. There were no children present during today's inspection. Present during today's visit was the Licensee fingerprint cleared daughter Hosena Mohammed. The hours of operation will be 7:00AM- 10:00pm, Saturday through Sunday.

The home was toured to conduct a health and safety inspection. The home is neat and clean with heating and ventilation for safety and comfort. The two story home consists of 4 bedrooms, 3 bathrooms (including master bathroom), living room, dining area, kitchen, garage, and backyard. Licensee will be utilizing the Living/Dining room of the home for day care with the downstairs bathroom. The kitchen walk way will be used only for children in care to access the backyard. There is a fireplace that is barricaded by TV with stand and is secured and made inaccessible to children. There are age appropriate toys and furniture in the day care rooms.

On limits: Living and Dining Room (Daycare rooms), Bathroom, (1st floor near dining area) and backyard.

Off limit areas: Entire second level of the home, Kitchen and the garage. Electrical outlets have child protective covers in place making them inaccessible to children. The garage will be used by for an indoor play space when the weather restricts use of the backyard. Licensee is aware of their responsibility to ensure that children never eat or sleep in the garage. There are ample age appropriate toys in good condition. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. The home has a fully charged 3A40BC fire extinguisher; appropriate smoke detectors/carbon monoxide detectors (tested and working).

See LIC809C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ABDUL RAHIM, AZIZEH
FACILITY NUMBER: 015700458
VISIT DATE: 05/03/2023
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The licensee’s Health and Safety training is completed, Licensee CPR and First Aid certificate is current and expires 2/19/2024 and Mandated Reporter is also current and expires 1/24/2022. Licensee is in compliance with immunization laws pertaining to family day care homes.

Licensee was reminded that CPR/First and Mandated Reporter training is to be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. Per licensee, there are no firearms in the home.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. All forms can be downloaded at www.ccld.ca.gov

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates and

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ABDUL RAHIM, AZIZEH
FACILITY NUMBER: 015700458
VISIT DATE: 05/03/2023
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LPA discussed the Safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep webpage 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.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

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/inspection-process

Notice of site visit given to Licensee Azizeh Abdul Rahim and must remain posted for 30 days.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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