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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384002305
Report Date: 02/29/2024
Date Signed: 02/29/2024 03:59:31 PM


Document Has Been Signed on 02/29/2024 03:59 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SARWAR, FOZIAFACILITY NUMBER:
384002305
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
02/29/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Fozia SawarTIME COMPLETED:
04:10 PM
NARRATIVE
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On 2/29/2024 at 1:05PM., Licensing Program Analyst (LPA), Luis J. Gomez met with Licensee, Fozia Sawar. The purpose of today’s visit was explained and was for an unannounced, annual random Inspection. Present was the licensee and licensee’s husband caring for 6 children (4 Infant-age, 2 Preschool- age). Licensee’s home is a 4 bedroom, 2 bathroom, 2 level house. Licensee’s days and hours of operation are: Monday- Friday: 7:30am- 5:30pm. The areas of the home used for care are: First Floor: Playroom; Bathroom #1; Bedroom #1; and Backyard. The areas of the home designated as off- limit are: First Floor: Garage; Kitchen #2; Entire Upstairs: Living room; Kitchen; Bedroom #2; #3; #4; and Bathroom #2. LPA inspected facility for health and safety hazards.

At 1:10PM., the following was observed: Facility was clean with age-appropriate playthings available for the children. Accessible furniture, puzzles, and toys inspected were in good repair. Playroom is equipped with cubbies for storage of children’s belongings. Licensee has several chairs and table, scaled to the size of the children. LPA observed several infant feeding chairs with attachable table component. For nap/ rest services, LPA observed several infant play pens located in bedroom #1.

At 1:15PM., Based on observations, LPA confirmed loose blankets and pillows inside of play pen with napping infant.

LPA reminded licensee bedroom door must remain open at all times, while infants in care are napping. Advisory Note: Technical Violation (LIC9102TV) was issued.

Per licensee, she washed napping sheets are washed weekly. Bathroom #1 was observed clean with supplies for hand washing. The facility was a comfortable temperature with ventilation and lighting. The off-limit areas have been made inaccessible with installed safety gates and locked doors. Home had functioning telephone service; carbon monoxide detector; smoke detector; and fire extinguisher: 2A:10:BC.

LPA inspected the backyard area. Area was completely enclosed with tall fencing, with turf installed for added safety. Playthings inspections were in proper repair. Home does not have any pools, fishponds, jacuzzi, or bodies of water.


(REFER TO 809c, FOR CONT)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
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 9


Document Has Been Signed on 02/29/2024 03:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: SARWAR, FOZIA
FACILITY NUMBER: 384002305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(b)(2)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (2) Six children, no more than three of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 1:55PM., Based on observations, interview and record review, LPA confirmed facility operating beyond the capacity limit stated on the license, with 6 children (4 infant-age) in care. This poses an immediate health and safety risk to children in care.
POC Due Date: 03/01/2024
Plan of Correction
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Licensee will reduce infant-age enrollment to the required capacity limit by the due date: 3/1/2024.
Proof of correction will be submitted to the department via email.

Authorized representatives will sign the LIC9224, ' Notice of A-type deficiency' and received copy of Facility Evaluation Report (LIC809) report.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/29/2024 03:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066


FACILITY NAME: SARWAR, FOZIA
FACILITY NUMBER: 384002305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 1:15PM., Based on observations, LPA confirmed loose blankets and pillows inside of play pen with napping infant. This poses a potential health and safety risk to children in care.
POC Due Date: 03/04/2024
Plan of Correction
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Licensee will review and implement all safe sleep regulation practices for napping infants- PIN20-24 CCP by the due date: 2/4/2024.

Proof of correction will be submitted to the Department via email.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 2:13PM., Based on record review, LPA confirmed LIC9227, Individual Infant Sleeping Plan' missing form qualifying infant’s facility file. This poses a potential health and safety risk to children in care.
POC Due Date: 03/08/2024
Plan of Correction
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Licensee will ensure form, LIC9227 Individual Infant Sleeping Plan is signed by Authorized Representatives. Completed form will be stored in the child's (C1) file.

Proof of correction will be submitted to the Department via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
LIC809 (FAS) - (06/04)
Page: 3 of 9


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SARWAR, FOZIA
FACILITY NUMBER: 384002305
VISIT DATE: 02/29/2024
NARRATIVE
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(Page 2)
At 1:50PM., LPA reviewed facility records including the children’s files.
Children’s files were reviewed and included the: Identification Information; Notification of Parent’s Rights (LIC995); Consent for Emergency Medical Treatment (LIC627).

At 1:55PM., Based on observations, interview and record review, LPA confirmed facility operating beyond the capacity limit stated on the license, with 6 children (4 infants-age) in care.

At 2:13PM., Based on record review, LPA confirmed LIC9227, Individual Infant Sleeping Plan' missing form qualifying infant’s facility file.

LPA reminded licensee documenting infant napping checks during for each 15-minute review. Advisory Note: Technical Violation (LIC9102TV) was issued.

Licensee’s Cardiopulmonary Resuscitation/ First Aid Certification (CPR) was current, expiring: 7/2024.
LPA reminded licensee to renew 'Mandated Reporter Certification' (AB1207). Advisory Note: Technical Violation (LIC9102TV) was issued.

Per Licensee, facility is conducting emergency disaster drill every month with last drill completed on 2/21/2024, properly logged.

The required forms are posted in facility, including the: License; Notification of Parent’s Rights (PUB379).

Per licensee, isolation of an ill child is in the playroom. Per licensee, she provides food service for children in care. LPA advised licensee to ensure all children’s food containers brought by families are be labeled. (REFER TO 809C, FOR CONT.)

SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC809 (FAS) - (06/04)
Page: 6 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SARWAR, FOZIA
FACILITY NUMBER: 384002305
VISIT DATE: 02/29/2024
NARRATIVE
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(Page 3)
Licensee was reminded that all adults 18 years and over living in the home, person who provides care and supervision to children, and staff who have contact with children, including employee and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain criminal 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 the Child Care Licensing Safe Sleep Web page at:https://www.cdss.ca.gov/inforesource/child-care-licesning/public-information-and-resources/safe-sleep as an additional resource. LPA informed licensee of the importance of checking for recalled infant devices on United States consumer Product Safety Commission (CPSC) website at http://www.cpsc.gov and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed of the www.mychildcareplan.org site is a consumer education website that helps families obtain child care by connecting to child care providers and resources and referral agencies (R&R) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 20-02-CCP. When an IMS is provided, a plan for 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- 0382 (TTY) and link to publications: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey may 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 tool, please send them 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/inforesource/community-care-licensing/inspection-process.
(REFER TO 809c, FOR CONT.)
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC809 (FAS) - (06/04)
Page: 7 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SARWAR, FOZIA
FACILITY NUMBER: 384002305
VISIT DATE: 02/29/2024
NARRATIVE
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(Page 4)
Based on today's inspection, deficiencies were observed in areas evaluated according to California Title 22, Div. 12 Chap. 3, Health and Safety, Code of Regulations and cited on 809D. Exit interview, Plan for Correction, and Facility Evaluation Report was reviewed with Licensee, Fozia Sawar. Licensee’s signature of this form acknowledges the receipt of these documents.

Licensee was issued Type “A” violation and was advised to provide a copy of the ‘Facility Evaluation Report’ and all Type “A” Deficiencies cited, to parents and guardians of children currently enrolled in care and to parents of newly enrolled children during the next 12 months.
Signed LIC 9224, ‘Deficiency and Acknowledgment of Receipt of Licensing Reports; shall be maintained in all children's files.

During exit interview, licensee, Fozia Sawar confirmed that there are no registered sex offenders living in the facility, and LPA completed the RSO profile. Notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Marie RodriguezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Luis GomezTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC809 (FAS) - (06/04)
Page: 8 of 9