Community Care Licensing

Document Has Been Signed on 04/21/2021 12:03 PM - It Cannot Be Edited

FACILITY NAME:	MASOOD, SOFIA		FACILITY NUMBER:	013418111
ADMINISTRATOR:	MASOOD, SOFIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 825-3099
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 12	DATE:	04/21/2021
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Sofia Masood- Licensee		TIME COMPLETED:	12:15 PM

SUPERVISORS NAME: Wynn Norona LICENSING EVALUATOR NAME: Briana Plumboy LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2021

Link to Parent Document Below:

FACILITY NAME: MASOOD, SOFIA	FACILITY NUMBER: 013418111
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/30/2021 Section Cited CCR 102417(a)	1 2 3 4 5 6 7	(a)The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.	1 2 3 4 5 6 7	Licensee shall review the regulation and submit a declaration to CCL stating that she has read and understands the regulation by 4/30/21. Licensee shall ensure she is present at the home at least 80 percent of the operating hours.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by:Based on several interviews, the licensee is not present in the facility at least 80% of the time, and her assistants are caring for the children in care the majority of the time which poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B 04/30/2021 Section Cited CCR102423(a)(2)	1 2 3 4 5 6 7	(a)(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.	1 2 3 4 5 6 7	Licensee stated she will buy 2 sets of tables and chairs. One for the family room and 1 outside to eat. By 4/30/21. Licensee will send LPA Plumboy pictures of the table and chair sets she puts in the childcare for eating.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews, the preschool age children eat meals and snacks at times inside the garage which poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

SUPERVISOR'S NAME: Wynn Norona LICENSING EVALUATOR NAME: Briana Plumboy LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2021

Link to Parent Document Below:

FACILITY NAME: MASOOD, SOFIA	FACILITY NUMBER: 013418111
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/30/2021 Section Cited CCR 102423(a)(1)	1 2 3 4 5 6 7	(a)(1) To be treated with dignity in his/her personal relationship with staff and other persons.	1 2 3 4 5 6 7	Licensee stated she will meet with her assistants, develop a redirection plan to follow and submit it with her and her 2 assistants present signatures.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews, the children in care feel the staff yell at them when they are being redirected which poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

SUPERVISOR'S NAME: Wynn Norona LICENSING EVALUATOR NAME: Briana Plumboy LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2021