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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419047
Report Date: 09/02/2021
Date Signed: 09/02/2021 12:34:40 PM

Document Has Been Signed on 09/02/2021 12:34 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:ADAM, NOREEN DANISHFACILITY NUMBER:
013419047
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
09/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Noreen Adam- LicenseeTIME COMPLETED:
12:45 PM
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On 09/02/21 at 11:44am, Licensing Program Analyst Briana Plumboy met with licensee Noreen Danish for an UNANNOUNCED ANNUAL REQUIRED INSPECTION. Present for this visit was licensees 1 preschool age child and 3 school age children. The home was toured by LPA Plumboy and licensee to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:00am until 5:00pm.

The home is a single family home. The home is neat with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the play/nap room which has 2 sections and is divided by a wooden wall, the kitchen/family room, living room, front yard, and hallway bathroom. The OFF LIMIT AREAS are the 4 bedrooms and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the living room. The FRONT YARD play area is fenced and has a locked gate. Licensee is aware when children are playing in the front yard, there must be 100% physical/visual supervision at all times. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water present in the on limit areas. 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 to the child in care during today's inspection.

The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee CPR and First Aid certificate is current and expires 05/2023. The licensee is in compliance with the immunization law. Per licensee, there are no firearms in the home. The licensee is in ratio today. Forms are posted and visible for public review. The licensee is being cited today for not having a documented fire/disaster drill or proof of completing the mandated reporter training.
See 809-C and 809-D for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ADAM, NOREEN DANISH
FACILITY NUMBER: 013419047
VISIT DATE: 09/02/2021
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, 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 encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Noreen Adam 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 Noreen Adam 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.

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

See 809-D for deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Noreen Adam.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/02/2021 12:34 PM - It Cannot Be Edited


Created By: Briana Plumboy On 09/02/2021 at 12:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADAM, NOREEN DANISH
FACILITY NUMBER: 013419047

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
CCR
102417(g)(9)(A)(1)

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Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.
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Licensee shall conduct a fire/disaster drill and submit copy of drill log to CCL by POC date of 09/10/21.
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This requirement was not met as evidenced by: Based on observation and record review of the fire drill log, the last fire/disaster drill was conducted more than 6 months ago which poses a potential risk to children in care.
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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
10/01/2021
Section Cited
HSC1596.8662(b)(1)

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On or before March 30, 2018..., a licensed child care provider...shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years following the date on
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Licensee will complete the Mandated Reporter Training at www.mandatedreporterca.com, and submit certificate of completion to Licensing by due date of 10/1/21.
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which he or she completed the initial mandated reporter training. Based on observation and interview, licensee does have proof of completing the mandated reporter training, which poses a potntial health & safety risk
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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.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wynn Norona
LICENSING EVALUATOR NAME:Briana Plumboy
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2021


LIC809 (FAS) - (06/04)
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