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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419047
Report Date: 05/05/2022
Date Signed: 05/05/2022 09:25:22 AM

Document Has Been Signed on 05/05/2022 09:25 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
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: 8CENSUS: 0DATE:
05/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Noreen Danish Adam- LicenseeTIME COMPLETED:
09:35 AM
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On 5/5/22 at 8:46am, Licensing Program Analyst Briana Plumboy met with licensee Noreen Danish for an ANNOUNCED CASE MANAGEMENT INSPECTION. Present for this visit was licensees teenage son. This facility was on inactive status effective 04/25/2022 and would like to be placed back on active status. The home was toured by LPA Plumboy and licensee. The facility currently operates Monday through Friday from 7:00am until 5:00pm.

The home is a single family home. The ON LIMIT AREAS are the living room, the second bedroom located on the left side of the hallway, front yard, and hallway bathroom. The OFF LIMIT AREAS are the 3 bedrooms, sunroom, the kitchen/family room, and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the second bedroom located on the left side of the hallway. 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 completed mandated reporter training on 09/27/21. The licensee is in compliance with the immunization law. Per licensee, there are no firearms in the home.

The facility is placed back on active status. No deficiencies cited during today's inspection. An exit interview was conducted. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Appeal rights provided and discussed. Exit interview conducted licensee.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
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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