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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409875
Report Date: 04/12/2023
Date Signed: 04/12/2023 03:33:59 PM

Document Has Been Signed on 04/12/2023 03:33 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:SHEIKH, SABRINAFACILITY NUMBER:
434409875
ADMINISTRATOR:SHEIKH, SABRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 957-0662
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Facility Representative Shaista SoroyaTIME COMPLETED:
03:50 PM
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On Wednesday, April 12, 2023, at 2 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year Visit. LPA met with the Licensee's daughter Shaista Soroya (Assistant Provider) and explained the nature of the site visit. Present for this visit were other 3 Licensee's Assistant (Fidela, Maria and Belqis), a Registered Behavioral Technician (Annette) for Child # 1, Licensee's son SHAHNAWAZ, 3 infants and 7 preschool children. The home currently operates from Monday to Friday 08:30 AM to 05:30 PM.

The home was toured to conduct a Health and Safety Inspection. The home is a two-story home. The home is neat and clean with heating and ventilation for safety and comfort.
The ON LIMIT AREAS are the dining room, kitchen, family room, garage converted to a day care classroom, day care office room, hallway bathroom, right side yard and a partial part of the backyard. The right-side yard and partial part of the backyard are the play area, are being used as an access to the day care by parents, are completely fenced and have self-latching gates.
The OFF-LIMIT AREAS are the entire second floor, living room, the backyard swimming pool which will be inaccessible by closed and or locked doors and or a self-latching fence with visual supervision. The ISOLATION AREA will be the day care office room. There are ample age-appropriate toys that appear to be safe and in good condition. All hazardous materials and toxins are kept out of the reach of children, and it was observed that there are no toxins or hazardous items accessible today.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The fireplace is screened to prevent access by children. As per the Assistants (Facility Representative), there are no firearms in the home. The home conducts and documents fire and disaster drills twice a year with the last one conducted on March 2023. Licensee owns the house and maintain signed the forms LIC 282 AFFIDAVIT REGARDING LIABILITY INSURANCE on each child's file. See 809 C.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SHEIKH, SABRINA
FACILITY NUMBER: 434409875
VISIT DATE: 04/12/2023
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The licensee and the licensee's Assistants CPR and First Aid certificate are current. The licensee and the licensee's Assistants completed the Mandated Reporter Child Care Providers training. The licensee and the licensee's Assistants have records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Sleep Log, LIC 9150, LIC 9227 and Immunization. The licensee is in ratio today.

Licensee does not transport children at this time. Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions and all vehicle occupants must be secured in an appropriate restraint system.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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



The facility representative was reminded that all adults 18 and over living or working in the home, 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.

SEE 809 C.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SHEIKH, SABRINA
FACILITY NUMBER: 434409875
VISIT DATE: 04/12/2023
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/inforesources/community-care-licensing/process.

LPA discussed the safe sleep to the facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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.

LPA provided copies to the Facility Representative the American Rescue Plan Act Survey and Child Care and Development Infrastructure Grant Program.

There are no deficiencies cited on this visit.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Assistant Provider (facility representative) Shaista Soroya.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
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