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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101021
Report Date: 03/30/2022
Date Signed: 03/30/2022 03:34:19 PM

Document Has Been Signed on 03/30/2022 03:34 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SHAHZAD, YASMEEN & HAMIDULLAH FAMILY CHILD CAREFACILITY NUMBER:
376101021
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
03/30/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Hamidullah Shahzad, Yasmeen Shahzad, Applicant and Co-ApplicantTIME COMPLETED:
12:15 PM
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On 3/30/22 at approximately 9:40 AM, Licensing Program Analyst (LPA) Daniel Pena and Licensing Program Manager (LPM) Renesha Pack conducted an announced change of location Prelicensing inspection with the Licensees, Hamidullah Shahzad & Yasmeen Shahzad. Also present in the home during the inspection was their 2 minor children. The 3-bedroom, 2- bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. A copy of the grant deed was provided as proof of control of property.

Applicant states that they have sufficient financial resources to sustain the license. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant 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, 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.

Applicant agreed to comply with all regulations and laws governing family child-care homes. First Aid and CPR for both licensees expires February 2024. Licensees completed preventative health practices, lead poisoning and nutrition courses on January 15, 2022. Mandated Reporter Training AB 1207 was completed on March 18, 2022.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SHAHZAD, YASMEEN & HAMIDULLAH FAMILY CHILD CARE
FACILITY NUMBER: 376101021
VISIT DATE: 03/30/2022
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Staff immunization requirements per SB792 were met. Applicant has the required immunizations. Applicant states that there are no weapons in the home.

Applicant will be using the following rooms for childcare: living room, kitchen, dining room and hall bathroom. The following areas will be off limits: garage, all bedrooms and bathroom 2 and the backyard. The off-limit areas either have safety latches, locks or doorknob covers to prevent access. There are no operating fireplaces. There are no bodies of water on the premises.
The fire extinguisher size 4A60BC, located in the livingroom, and the smoke and carbon monoxide detectors are operational and meet requirements. All hazardous items were latched/locked and secured out of reach of children. The applicant has sufficient toys and equipment available. Outdoor play will occur at a nearby public park. Licensee acknowledges that visual supervision is always required when children are outside.

The new provider packet was reviewed with the applicant including information on ratios and capacity, child abuse reporting, children’s records, immunizations, adults living or working in the home, car seat law, shaken baby syndrome, SIDS, safe sleep practices, effects of lead poisoning, and the YMCA Resource Center. Per Licensee they will be providing transportation, LPA discussed carseat and transportation requirements/recommendations. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers, and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.
LPA discussed and provided applicant with the following information:
· Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov.

· For common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed applicant 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: Renesha Pack
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SHAHZAD, YASMEEN & HAMIDULLAH FAMILY CHILD CARE
FACILITY NUMBER: 376101021
VISIT DATE: 03/30/2022
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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: http://www.ada.gov/childqanda.htm

LPA reviewed with applicant, 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 applicant. 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 platform. To receive important licensed-related information to licensed facilities, visit the CCLD
website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed prior to the issuance of the license:

1) Updated LIC610A Emergency Disaster Plan must be posted
2) Updated LIC999/999A Facility Sketch must be posted

Copies of the above will be emailed to applicant upon return to the office. Applicant understands that corrections must be submitted to the Department within 30 days, no later than 4/30/22, or the application may be denied.

An exit interview was conducted, and a copy of this report was reviewed with and provided to the Licensee.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC809 (FAS) - (06/04)
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