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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700458
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:19:37 PM

Document Has Been Signed on 08/08/2024 04:19 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/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
08/08/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Azizeh Abdul RahimTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On August 8th, 2024 at approximately 2:05pm, Licensing Program Analyst (LPA) April Wright arrived for an unannounced Annual/Random Inspection and met with Licensee Azizeh Abdul Rahim. Present during inspection was one (1) preschool age child in care. Present during today's visit was the Licensee fingerprint cleared daughter. The home was toured to conduct a health and safety inspection. The hours of operation will be 7:00AM- 10:00pm, Saturday through Sunday.

The two story home consists of four (4) bedrooms, three (3) bathrooms (including master bathroom), living room, dining area, kitchen, garage, and backyard. The home is neat and orderly with heating and ventilation for safety and comfort. There are age appropriate toys and furniture that LPA observed to be in safe and good condition, free of visible damage or hazards. LPA observed that the outdoor play area is fenced, free of defects and damage. LPA observed and Licensee confirmed that are no toxins, medicines, cleaning products or hazardous materials visible during today's inspection and were made inaccessible to children in care. There is a fireplace barricaded by a TV with stand that is secured and made inaccessible to children.

On limits areas: Living and Dining Room (Daycare area), Bathroom, (1st floor right of dining area), backyard and kitchen walk area for access the backyard only.

Off limit areas: The entire second level of the home that includes the three remaining bedrooms, 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 and working smoke/carbon monoxide detectors. Licensee confirmed and LPA observed that there are no pets, firearms or weapons in the home.

See LIC809C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 08/08/2024
NARRATIVE
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All individuals subject to criminal record review have a clearance or exemption and have been associated to this FCCH. LPA requested and reviewed the files of one (1) children in care. The children's files contained, Parents rights, medical consent forms, identification and emergency contacts. The children's roster was reviewed and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 5/2/2024. The licensee has current Mandated reporter training which was completed on 8/8/2024 and CPR/First aid certificate has expired. Licensee provided proof to LPA of training was scheduled through 4C's to be completed. Licensee is in ratio today. All required forms are posted and visible for public viewing.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

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: https://www.ada.gov/resources/child-care-centers/.

See LIC809C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
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: 08/08/2024
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During the exit interview, the Licensee Rahim, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Azizeh Abdul Rahim.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
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