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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625556
Report Date: 02/08/2024
Date Signed: 02/08/2024 01:55:08 PM

Document Has Been Signed on 02/08/2024 01:55 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MAHMOOD, ABIDAFACILITY NUMBER:
343625556
ADMINISTRATOR:MAHMOOD, ABIDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 623-6510
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
02/08/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Abida MahmoodTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Jennifer Velasco met with Licensee Abida Mahmood (Licensee), for the purpose of an announced pre-licensing inspection. This is a relocation of facility 343625218 and capacity change inspection. Fire marshal clearance was approved 01/31/2024 for facility to provide care on both first and second floor. Garage is not approved for child care use. All individuals subject to criminal background review have obtained a criminal record clearance. Hours of operation: Monday through Friday from 7:00 AM to 9:00 PM.

A health and safety inspection was conducted on the interior and exterior of the home. Off-limit areas will consist of: The garage, utility closets, three bedrooms and one bathroom upstairs and one bedroom downstairs. Stairs are accessible but will be gated at top and bottom prior to licensure. Toxic and hazardous items, sharp knives, and medications are inaccessible to children. LPA observed a functioning smoke detector and carbon monoxide detector within the home. Licensee stated that there are no poisons in the home. LPA advised the Licensee that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. Licensee stated there are no weapons or bodies of water on the premises.

Licensee has completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training. Current EMSA approved pediatric CPR/First Aid training were completed and expire 07/2024. Licensee has current Mandated Reporter Training, which expires 09/2024. Licensee understands CPR training and Mandated Reporter training must be completed every two years.

LPA discussed capacity and supervision with Licensee. Licensee understands that if an unusual incident occurs, licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. LPA discussed Type A/B citations, open door policy, fire drills, children’s personal rights with the Licensee. Licensee understands a current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer attending.

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SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MAHMOOD, ABIDA
FACILITY NUMBER: 343625556
VISIT DATE: 02/08/2024
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LPA explained to Licensee that if they relocate and want to continue to provide care, they must submit a change of location application and have the new home inspected. Licensee understands that if any structural changes are made to the home, licensing must be notified prior to construction. Licensee understands that if they want to make any off-limit area an on-limits area, licensing must be notified and LPA must do an inspection before children are allowed in the area. Licensee understand that licenses are not transferable, and once licensed, licensees must live in the home and be present for 80% of the operating hours.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 five 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.

Licensee provided proof of control of property. The Licensee owns the home.

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) or (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 reviewed with Licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the Licensee.

LPA discussed with Licensee the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at: https://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.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MAHMOOD, ABIDA
FACILITY NUMBER: 343625556
VISIT DATE: 02/08/2024
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On 02/08/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The following items must be completed prior to licensure:

1. Postings must be posted near front entrance.

2. Top and bottom of stairs must be gated.

Exit interview conducted and report was reviewed with the Licensee Abida Mahmood..

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
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