015700082-6-18-2021-52-CC-RHAR-C44VD4-20210618162009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700082
Report Date: 06/18/2021
Date Signed: 06/18/2021 04:20:18 PM

Document Has Been Signed on 06/18/2021 04:20 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	AHMED, SYEDA AND SHARIF		FACILITY NUMBER:	015700082
ADMINISTRATOR:	AHMED, SYEDA AND SHARIF		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 364-1120
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/18/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Syeda Ahmed		TIME COMPLETED:	04:29 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On June 18, 2021, at approximately 2:35pm Licensing Program Analyst (LPA) Russ Haderer met Licensee Syeda Ahmed for the purpose of conducting an unannounced inspection for Health and Safety compliance. Present in the home today was the licensee, her fingerprint and TB cleared husband Sharif arrived at 3:34pm. The facility is open and ready for children but due to covid, no children are in care at this time. Operating hours remain the same Monday to Friday, 7:00am to 6:00pm.

The facility remains licensed the same as when pre-licensing was completed on May 28, 2020.

The facility is a single story home rented by the licensee consisting of a family room, living room, kitchen, full house bathroom in hallway, four bedrooms, two which are master bedrooms with an additional private full bathroom each. The home has an enclosed patio room, an open front yard, a (fenced) backyard and a two-car attached garage. The home is neat and clean with heating and ventilation for safety and comfort. Some windows had louvered shades, no pull cords present. Per the applicant, the ISOLATION AREA will be family room away from children in care.

On-limit-areas include: The living room, family room, kitchen, hallway bathroom, patio room and grassy area of the fenced backyard. Licensee is reminded that other than wipes or things used for the children in the on-limits children’s bathroom, they need to be empty of most all items such as cleaning products (or locked up) etc. The kitchen has gates, a sliding door and all appropriate latches for safety mounted in all cupboards and drawers within the children's reach (see last page). There were no hazardous items in any drawers or cupboards. Electrical outlets have protective plastic inserts.

Off-limit-areas include: The front yard, north side yard of the home, all four bedrooms including their respective bathrooms attached to the master bedrooms and the two-car garage. The off-limit areas will be inaccessible by closed and/or locked doors (door handles have child proof covers). Continued on page 2.....

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AHMED, SYEDA AND SHARIF	FACILITY NUMBER: 015700082
	VISIT DATE: 06/18/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Fire Alarm pull down alarm and siren are present, fire rated door to the garage, exit signs and escape direction arrows appropriately located. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. Although off limits, the backyard has a storage shed for storing non-hazardous items. There are age appropriate toys, learning materials, and equipment that appear to be safe and in good condition.

The home has a fully charged 3A40BC fire extinguisher, working smoke and carbon monoxide detectors (both tested), and a working telephone. The Health and Safety training is completed, and CPR and First Aid certificate is current and expires 01/2023. The licensee was reminded CPR/1st Aid training is required every two years. Mandated Reporter training is up to date and expires 5/14/2022. The licensee is in compliance with the immunization laws which pertains to day care providers.

There is covered fireplace (physical cover bolted over the front), per licensee, there are no firearms in the home. A copy of the rental agreement was reviewed and a property owner consent form was signed Oct 8, 2019 allowing applicant to operate a large Family Child Care Home (FCCH) for up to 14 children. Ratios were discussed.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Individual Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

LPA reminded baby bouncers & drop-down cribs are not allowed at the day-care facility.

Continued on Page 3.................

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: AHMED, SYEDA AND SHARIF	FACILITY NUMBER: 015700082
	VISIT DATE: 06/18/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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

The child-proof locks on kitchen cupboard doors below the sink are weakened and need to be replaced. Since there are no children in care at this time, they are not an immediate threat, however, they must be replaced within 30 days. The gate on the west side of the yard needs a padlock added for safety.

There were no deficiencies found during today's inspection. This report will remain on file for three years.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3