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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416568
Report Date: 03/05/2024
Date Signed: 03/05/2024 04:11:46 PM

Document Has Been Signed on 03/05/2024 04:11 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KHURRAM, TAHIRAFACILITY NUMBER:
434416568
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 3DATE:
03/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tahira KhurramTIME COMPLETED:
04:20 PM
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Licensing Program Analysts (LPAs) Mandeep Kaur and Samantha Yip conducted an unannounced Case Management- Licensee Initiated inspection with Tahira Khurram, Licensee. The purpose of today's inspection: address the Application for a Large Family Child Care Home license (Capacity Change) that the Licensee submitted to the Department on February 16, 2024. Licensee is currently licensed for Small Family Child Care Home (FCCH). Licensee has been licensed since 04/01/2014; therefore, she has at least one year of experience as a family child care provider to apply for a Large FCCH. A fire Clearance for Large Family Child Care Home was granted on 02/27/2024.

LPAs observed that 3 children were present in the home during today’s inspection. Also present during today's inspection are Shahnaz Tabassum. Licensee stated that she, her husband and adult children are the adults residing in the home. Days and hours of operation are Monday to Friday from 7:30 AM to 6:30 PM. The Licensee completed the Preventative Health and Safety Child Care Training on 12/06/23 and a copy of the certification is on file. The Licensee has proof of Pediatric CPR and First Aid training on 03/13/23 on file. A copy of current TB test, flu , MMR, and Tdap vaccinations for the Licensee are on file. Proof of completion of the Mandated Reporter Training for Child Care Workers (completed on 07/31/23) is on file. The Licensee owns the home and copy of grant deed verifying control of property is on file. The Licensee has childcare liability insurance valid until 1/20/25 on file. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's inspection.

The Licensee agreed to give LPAs a tour of the home (indoor/outdoor) during today's inspection.

LPAs observed the home is a single-story home with three (3) bedrooms, (2) bathrooms, living room, kitchen with dining area, garage, and backyard. There is a working telephone in the home (cell #408-390-9810). The home is clean and orderly, with heating and ventilation for safety & comfort.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KHURRAM, TAHIRA
FACILITY NUMBER: 434416568
VISIT DATE: 03/05/2024
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LPAs observed no fireplace and no wall heaters. The off-limit areas inside the home are: master's bedroom with bathroom, bedroom #1, kitchen/dining and attached garage. There are safe and age-appropriate toys, play equipment, and materials for the children in the home. The Licensee has a designated area in the home (bedroom 2) where a child(ren) can be isolated if exhibiting signs of illness. The home has at least 1 working smoke and carbon monoxide detector in the home (tested by the Applicant during today's inspection). The Licensee has one fully charged fire extinguisher (3A40BC) inside the home. The Licensee states she does not have any pets or weapons in the home. All cleaning compounds and medications are adequately stored (locked cabinets) and garage inaccessible to children. LPAs reminded Licensee that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. The Applicant has a first aid kit in the home, with sufficient emergency supplies, including a no-touch thermometer.

Kitchen tour: LPAs observed the refrigerator and freezer in the home are clean. There were sharp utensils, cleaning products that licensee moved to children inaccessible area. There are no lighters/matches, or open bottles of alcohol accessible to children. The Licensee provides the food if needed and understands that food and any bottles served to the children need to be labeled with their names. The Licensee understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

Bathroom tour: LPAs observed the bathroom toilet and faucet are clean, safe, and operable. The shower is free of any hazards. All shampoos, soap, medication, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover are inaccessible to the children.

Outdoor tour: LPAs observed the outdoor backyard of the home is fenced, safe, and secure for the children. There are no bodies of water in the backyard. LPAs reminded Licensee to dump any water that collects in the containers. Off-limit area outdoor: None. Licensee was advised that outdoor play shall be supervised at all times.

Forms of discipline to be used by Licensee: talking to children and redirecting. The Licensee understands that children's personal rights should not be violated; including no corporal punishment, supervision of children, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Licensee during today's inspection.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KHURRAM, TAHIRA
FACILITY NUMBER: 434416568
VISIT DATE: 03/05/2024
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This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Licensee 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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
as an additional resource. LPA also informed Licensee 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.

On this date, 12/18/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KHURRAM, TAHIRA
FACILITY NUMBER: 434416568
VISIT DATE: 03/05/2024
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LPAs discussed the Large Family Child Care Home Ratio and Forms/Records to Keep in Large Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families


obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs)
throughout California.

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

Licensee will submit:
1. Updated LIC610A (Emergency Disaster Plan for Family Child Care Home).
2. Concrete Planters will be filled with either small rocks or Soil.
3. Assistant CPR/First Aid certificate.

Exit interview conducted and report was reviewed with Licensee Tahira Khurram. LPAs
advised Licensee that Large Family Child Care Home license will be issued upon completion of the following:

1. Licensing Program Manager (LPM) review and approval.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
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