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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421011
Report Date: 02/15/2024
Date Signed: 02/15/2024 11:28:43 AM

Document Has Been Signed on 02/15/2024 11:28 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:JAVED, AYESHAFACILITY NUMBER:
013421011
ADMINISTRATOR:JAVED, AYESHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 524-0351
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
02/15/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Ayesha JavedTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee Ayesha Javed for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was Licensee supervising nine (9) Children(three infants and six preschoolers). The Licensee lives in this house with her husband and minor children. The home is two-story with four bedrooms, three bathrooms, a living room, a family room, a kitchen, a dining room, a laundry room, a garage, and a back yard. The hours of operation are 8:00 am to 6:00 pm Monday -Friday.
On Limit areas: the family room, kitchen, dining room, and living room (main daycare area)
Off-limit areas: the entire second floor and garage. All off-limit areas are inaccessible by closed and locked doors and visual supervision.
LPA inspected the house for health and safety hazards. The daycare Area is clean, orderly, and equipped with age-appropriate toys. The home has a working telephone, a smoke and carbon monoxide detector, and a fire extinguisher meeting the minimum requirements. There are no bodies of water in the daycare area. A fireplace in the daycare room is not in use during an operational hour and is screened to prevent access to the children. There is a safety gate at the base of the stairs to prevent access to the second floor. The Licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted on 01/2024. There are child-size tables and chairs for snacks and activities. There are ample age-appropriate toys that appear to be safe and in good condition. The napping room had cots in good condition, and each child had separate blankets. Per licensee, the parents wash the blankets and sheets weekly. The Licensee states there are no guns or weapons of any kind in the home. There are no pets in the house. The outdoor play area is fenced and is free from defects and dangerous conditions. The Licensee has valid CPR, which expires on 10/2025. The Mandated Reporter Certificate is current on the file. The Licensee provides daily snacks and meals. Discipline policy is redirection. LPA reviewed children's files. The Licensee documents 15-minute sleep checks.

See next page...
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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Document Has Been Signed on 02/15/2024 11:28 AM - It Cannot Be Edited


Created By: Jyoti Saini On 02/15/2024 at 09:55 AM
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: JAVED, AYESHA
FACILITY NUMBER: 013421011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, interviews, and record review, the Licensee did not comply with the section cited above as the Licensee alone was supervising nine (9) Children ( three infants and six preschoolers), which poses an immediate health, safety, or personal rights risk to persons in care.
POC Due Date: 02/16/2024
Plan of Correction
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 LPA discussed ratio requirements for a large family childcare home with a licensee. The licensee shall comply with the capacity requirements for a small family child care home if no assistant is present. An assistant is always required to operate a large family childcare home. Licensee is to submit a statement of understanding of this regulation and submit it to LPA via email by 02/16/2024. LPA will return on another date to ensure compliance.
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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


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: JAVED, AYESHA
FACILITY NUMBER: 013421011
VISIT DATE: 02/15/2024
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During Inspection, Licensee was reminded that all adults 18 and over living or working in the home, 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 at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.



Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Type A deficiency is cited during today’s inspection ( see LIC809-D) and two technical violations were given.



LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.

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

Exit interview conducted and report was reviewed with the licensee, Ayesha Javed.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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