434416470-11-29-2022-07-CC-AALZ-CLMSMC-20221129125943

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416470
Report Date: 11/29/2022
Date Signed: 11/29/2022 01:00:56 PM

Document Has Been Signed on 11/29/2022 01:00 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MARJI, SABREEN		FACILITY NUMBER:	434416470
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 3	DATE:	11/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Marji, Sabreen		TIME COMPLETED:	01:30 PM

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On this day Licensing Program Analysts (LPA/s) Almaraz conducted Unannounced inspection, for a small family childcare home (capacity of 8). Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA/s met with Licensee Marji, Sabreen. There were 3 children present during the inspection, all infants over 12 months. Hours of operation are 7AM to 5PM, Monday thru Friday. There are 2 adults residing in the home (criminal record clearances on file). Licensee and spouse Marji, Marwan and two minor children, including one preschooler age.

Physical Plant: This dwelling consists of 4 bedrooms and 1.5 lavatories. LPA/s inspected the indoor and outdoor areas of the home today. Per licensee Off limit areas in the home are as follows: Kitchen, made inaccessible with a gate. Laundry room, which is in the off-limits garage made inaccessible with a lock. Master bedroom inaccessible with a safety knob. Off limit areas outside the home are as follows: Left and right side of yard both gated. LPA observed side gates and floor have a slight gap and has advised to place something to obstruct this. The back yard is fully fenced. The front yard is safety complaint.
During this inspection, the following was noted: LPA/s began tour through the interior of the home. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating for safety and comfort.

Kitchen: All kitchen areas/food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. LPA checked that water and refrigerator temperatures in standard condition. Per licensee waste is to be discarded immediately after each meal.

Food: Per licensee meals are prepared at the facility daily. Licensee provides breakfast, lunch and AM/PM snacks. LPA and licensee discussed that food brought from home should be labeled. Per licensee there are currently no children enrolled with allergies. LPA has advised licensee to keep an allergy list in the kitchen area, should there be any children enrolled with allergies. LPA and licensee discussed having the 5 food components kept on site. 1/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARJI, SABREEN	FACILITY NUMBER: 434416470
	VISIT DATE: 11/29/2022

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All areas identified on the facility sketch were inspected. Areas that are accessible to daycare children are the living room, one bedroom for changing and napping, and backyard. Licensee has no pets. The licensee understands that areas that are off-limits must remain inaccessible to the children in care during operating hours. The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

Lavatories: There is one lavatory that is accessible to the children in care. There is a change table, that is appropriate for the children in care. Licensee states that potty training is not provided at facility.

Outdoor play: The fully fenced back yard has adequate shade in the backyard.

Hazards: LPA did not observe any hazards inside the home. Electrical outlets are in the garage and inaccessible. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children was observed out of reach, locked to the children in care. Licensee states that there are no poisons in the home. The Licensee was advised that any poisons must be locked with a key or combination lock. LPA also observed appropriate equipment, toys, and games for children. Per licensee there are no firearms in the home. There are no bodies of water inside or outside of the home.

Fire & Safety: Carbon monoxide detectors and smoke detectors are working and present in the facility. There is a fire extinguisher, size 2A40BC purchased at the end of 2021; it was observed to be full. Last fire drill 07/23/2022; licensee understands a fire drill is to be completed at least every six months. There is a screened fireplace in the home, licensee states the fireplace is not used. There is one wall heater in an area not used by children. LPA and licensee discussed getting a mesh cover for best practice. Per applicant there is no smoking in the home.

Facility Records: The applicant has completed the required Health and Safety Training, Nutrition Training, Licensee has CPR and First Aid, valid until 02/13/2023. Applicant has MMR & Tdap vaccinations, and flu vaccine. Spouse and licensee have record of TB. Licensee has completed the Mandated Reporter Training valid until 11/29/2024. Licensee understand this must be renewed every two years. LPA reviewed three children's files and the files were complete with the required forms. LPA reviewed staff files and the files were complete with the required forms. LPA issued an LIC 857 and LIC 859 during this inspection.

Sign in and out: Per licensee there is a sign in/sign out system. LPA informed licensee that this is not mandatory for a FCCH.

Waivers: There are no waiver requests on file. 2/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARJI, SABREEN	FACILITY NUMBER: 434416470
	VISIT DATE: 11/29/2022

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Medical & First Aid Supplies: There is a first aid kit in the home, kept in kitchen area. LPA and licensee discussed that medication is only to be administered to a child when accompanied with a doctor's note, parent plan, authorizations are to be completed monthly. The medication shall be kept in a locked cabinet or in a locked box in refrigerator if needed and/or in emergency backpack when children outside (at least six feet high) which is to be stored out of reach of children. Per licensee there are currently no children requiring IMS.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Matts and cots: Per licensee napping is be done at this facility. LPA observed matt for napping in a safe condition with no exposed foam. Constructed of material at least 3/4 inch thick. Designed so that the sleeping side can be distinguished from the floor side. Per licensee this is covered with a sheet, bedding is not shared. The current children enrolled nap in play pens.

Per licensee sheets/blankets shall be when soiled and are washed weekly. LPA reminded applicant that bedding shall be individually stored so that each child's bedding is identifiable, and no child's used bedding shall meet other bedding. Bedding may be stored on top of each cot, so as not to touch.

Safe sleep: LPA/s observed and inspected sleeping equipment for infants. LPA/s observed cribs for each infant who is unable to climb out of the play yard. All equipment meets the US Consumer Product Safety Commission safety standards. Please see www.safekid.org for a list of any recalled products. LPA/s observed that cribs are free from loose articles and objects. There are no objects hanging above or attached to the side of the cribs. LPA reminded licensee that play yards shall not hinder the entrance or exit to and from the space children are sleeping in. LPA licensee reminded that mattresses are to be firm and covered with a fitted sheet that is appropriate to the mattress size.

Each infant must have their individual bedding, to be washed daily or as required. Bedding must be replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers must not be attached to anything. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was discussed. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the applicant, including but not limited to documentation that shall be maintained. A review of PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss and a copy was provided to the Licensee during this inspection. LPA reminded licensee that staff shall physically check on infants every 15 minutes and document the following: 1. Breathing, Sleep position, signs of distress. 3/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARJI, SABREEN	FACILITY NUMBER: 434416470
	VISIT DATE: 11/29/2022

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LPA advised licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. For commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Postings: LPA observed the required postings, including, Parent’s Rights Poster (with complaint Hotline), an emergency disaster plan, the license and any notice of site visits.

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/inspection-process

Licensee was reminded that all adults 18 and over, 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 Child Care Center. 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.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.

The following was discussed with the applicant:

-Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalty will be assessed if not in compliance.

-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated with the facility license.

-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

-Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. 4/4

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARJI, SABREEN	FACILITY NUMBER: 434416470
	VISIT DATE: 11/29/2022

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-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes, and/or if you move from your home.

-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report).

-Fire and safety drills must be performed every six months and documented for review by the Department.

-Smoking is prohibited in a family childcare home.

-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines, and any other item that falls into that category are not permitted in the facility.

-All adults living and working in the home shall be made aware of the Department's right to inspection authority, which includes but is not limited to the right to enter the home when children are being cared for, interview children and adults, and review documentation.

- Licensees shall reveal each facility license number in all advertisements, publications, or announcements with the intent to attract clients.

- Emergency Disaster Plan, Parent’s Rights Poster, and the Facility License are required to be posted.

Per Licensee day care currently carries liability insurance or a bond in accordance with the standard established by the Family Child Care statute. The law requires a Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file. Signed statements (LIC282) shall be in the children’s files.

LPA consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Patent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection. LPA advised the licensee how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms: Children forms/records, Facility forms/records, facility forms/ records, and Information to be posted in the Family Child Care Home.5/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARJI, SABREEN	FACILITY NUMBER: 434416470
	VISIT DATE: 11/29/2022

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During this inspection, Licensing staff consulted with licensee regarding COVID-19 health and safety guidelines on this date, licensee was provided CCP- COVID 19 Self- Assessment and forms to post. Per applicant, the following safety precautionary measures will be taken during the pickup and drop off of children: Daily health checks and screening upon entry will be conducted by Licensee.

The following was discussed with licensee: 1. Screen wall heater. 2. Allergy list. 3. Place something under side gates to make gap between bottom and floor smaller. Licensee is currently in compliance and understands this is for best practice to avoid potential citations.

This facility meets the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of the California Code of Regulations. Licensee understand the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

An exit interview conducted, and report was reviewed with licensee.

There are no deficiencies cited during todays inspection in accordance with Chapter 1, Division 12, Title 22 of the California Code of Regulations.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS 6/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

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