434415436-9-29-2022-07-CC-PHEZ-CJQPEF-20220929111503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415436
Report Date: 09/29/2022
Date Signed: 09/29/2022 11:15:11 AM

Document Has Been Signed on 09/29/2022 11:15 AM - 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 JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	AHMED, SAIMA & AHMED, TARIQ		FACILITY NUMBER:	434415436
ADMINISTRATOR:	SAIMA AHMED		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 821-5658
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY:	14	CENSUS: 4	DATE:	09/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Tariq Ahmed		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA), Pete Hernandez met with Licensee, Tariq Ahmed, and conducted an unannounced required 1 year inspection. There are 5 adults residing in the home: Licensees and their 3 adult children Ziad, Sana; Zaliakha and 2 minor children. LPA observed 4 children (2 infants and 2 preschoolers.) Days and hours of operation will be Monday - Friday from 7:30 AM to 6:00 PM. LPAs toured the indoor and outdoor areas. Off limit areas inside the home: kitchen, laundry room, utility room, two bathrooms, and two additional bedrooms as well as the master bedroom and bathroom and master bedroom office. Off limit areas outside the home: garage, fenced right side yard, and storage shed. The Licensee has a working telephone in the home. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is orderly, and safe for the day care children. On limit areas inside the home. Back bedroom/playroom, living room, family room, dining room, front bedroom near entry, and children's bathroom ( located in the back playroom.) On limit area outside the home is the fenced in area of the back yard that is accessed by the family room sliding glass door. LPAs observed a fully charged 3A40BC fire extinguisher. There are working hard wired smoke & carbon monoxide detectors in the home with fire pull stations. LPA didn't observed any bodies of water. Licensee understands that all pools, spas, hot tubs, fish ponds, or similar bodies of water shall be covered or fenced as specified in title 22 regulations to be inaccessible to children. The Licensee stated that there are no firearms or dangerous weapons in the home. LPAs observed current roster and provided a copy to the LPA. Also observed was the fire / emergency drill log that is updated every 6 months: last entry was 7/5/2022. All required postings are easily observed in the back entry room. The licensee also maintains a daily sign in sheet for the parents sign. All detergents, cleaning compounds, other similar items and poisons are in the garage and are inaccessible to children. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 09/29/2022

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: AHMED, SAIMA & AHMED, TARIQ	FACILITY NUMBER: 434415436
	VISIT DATE: 09/29/2022

NARRATIVE

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LPA reviewed the files of 4 enrolled children and the two Licensees and all the files have all of the required documentation and immunization's.

Incidental 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 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

A review of staff records today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12- month period

Supervision of children was discussed with the Licensee. Licensee understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed.

LPA informed Licensee that Licensing forms and Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov
LPA discussed and provided Safe Sleep Child Care information to the Licensee.
LPA disscussed the Individual Infant Sleep Plan and the form LIC9227 with the Licensee.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 09/29/2022

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: AHMED, SAIMA & AHMED, TARIQ	FACILITY NUMBER: 434415436
	VISIT DATE: 09/29/2022

NARRATIVE

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Licensee's have a current Mandated Reporter Certificate. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

Website for resource information: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA observed two current CPR and First Aid cards on file.

LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov

Type A language: Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, A copy of this report was discussed and left with the Licensee, Tariq Ahmed, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC809 (FAS) - (06/04)

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