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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419185
Report Date: 06/10/2024
Date Signed: 06/10/2024 12:53:20 PM

Document Has Been Signed on 06/10/2024 12:53 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BEGUM, SHANAZFACILITY NUMBER:
013419185
ADMINISTRATOR/
DIRECTOR:		BEGUM, SHANAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 709-5205
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
06/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Begum ShanazTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On June 10th, 2024 at approximately 10:30am, Licensing Program Analyst (LPA) April Wright met with licensee Shanaz Begum for an Unannounced Annual/Random Inspection. Present during today's inspection were two (2) children (one preschool/school age) and the licensee fingerprint cleared daughter. LPA toured the home to conduct a health and safety inspection. Hours of operation are 7:00am - 7:00pm Monday through Friday.
On limit areas: Living/Dining room (Daycare areas), kitchen, Master bedroom (napping only), bathroom #1 (down hallway to left) and backyard.
Off-limits areas: Bedrooms #2 and #3, master bathroom, Shed and garage. The off limits area are and will be made inaccessible by closed and/or locked doors and visual supervision.

The home single story home consists three bedrooms, two bathrooms, kitchen, dining area, backyard and garage. The home is neat and orderly with heating and ventilation for safety and comfort of children in care. The outdoor play area is completely fenced and is free of defects and damage which also has a locked storage unit in the backyard. There are age appropriate toys and furniture that LPA observed to be safe and in good condition, free of visible damage or hazards. LPA observed and Licensee confirmed that are no toxins, medicines, cleaning products or hazardous materials visible during today's inspection and were made inaccessible to children in care.

There is a 2A10BC fire extinguisher located in the kitchen which is fully charged and ready for use. Licensee carbon monoxide/smoke detector were not working and removed from their locations in the home. Licensee has a stocked first aid kit. LPA observed and Licensee confirmed that there are no pools, hot tubs or any bodies of water present in the home. The fireplace is not in use per Licensee and is locked with a gate and blocked by a table making it inaccessible to children in care. Per licensee, there are no firearms or weapons in the home. See LIC809 -C for continuance
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BEGUM, SHANAZ
FACILITY NUMBER: 013419185
VISIT DATE: 06/10/2024
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All individuals subject to criminal record review have a clearance or exemption and have been associated to the this FCCH. LPA requested and reviewed the files of two (2) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The children's roster was reviewed and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 1/12/2024. The licensee has current Mandated reporter training which was completed on 7/12/2022. Licensee CPR/First aid certificate expired on 4/9/2024. The licensee is in ratio today. All required forms are posted and visible for public viewing..

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP . 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: https://www.ada.gov/resources/child-care-centers/.

See LIC809C for continuance.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BEGUM, SHANAZ
FACILITY NUMBER: 013419185
VISIT DATE: 06/10/2024
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During the exit interview, the Licensee Shanaz, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Licensee received 2 violations and was cited during this inspection. Please see LIC 809D for further details.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Begum Shanaz.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 06/10/2024 12:53 PM - It Cannot Be Edited


Created By: April Wright On 06/10/2024 at 12:14 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: BEGUM, SHANAZ
FACILITY NUMBER: 013419185

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation , the licensee did not comply with the section cited above in which the smoke and carbon monoxide detectors were not working at time of inspecion, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2024
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chandra Charles
LICENSING EVALUATOR NAME:April Wright
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/10/2024 12:53 PM - It Cannot Be Edited


Created By: April Wright On 06/10/2024 at 12:14 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: BEGUM, SHANAZ
FACILITY NUMBER: 013419185

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which Licensee CPR/First Aid expired April 9th, 2024, poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2024
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chandra Charles
LICENSING EVALUATOR NAME:April Wright
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
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