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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422602
Report Date: 02/27/2024
Date Signed: 02/27/2024 12:50:17 PM

Document Has Been Signed on 02/27/2024 12:50 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:RAHIMI, HAFSAFACILITY NUMBER:
013422602
ADMINISTRATOR:RAHIMI, HAFSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 938-5588
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/27/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Hafsa Rahimi- LicenseeTIME COMPLETED:
01:00 PM
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On 2/27/24, Licensing Program Analyst (LPA) Briana Plumboy conducted an unannounced Required Annual Inspection with Licensee Hafsa Rahimi. Present for the inspection was 4 infants, 2 preschool age children, fingerprint clear assistant Lailoma Sarag, and licensees fingerprint clear and associated sister Awesta Rahimi. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am until 6:00pm.

ON LIMITS: the family room, downstairs bathroom, dining/living room, and backyard

OFF LIMITS: entire second floor, the garage, and the kitchen

There is a child safety gate located across the kitchen, another child safety gate at the step located between the restroom and family room, and another child safety gate located at the bottom of the stairs. Per the 850 approved Fire Clearance at no time shall children in care be in the garage, second story of the home, or the kitchen. The ISOLATION AREA will be the living room. The BACKYARD play area is completely fenced. Per licensee, the children play in the center part of the backyard, and not on the sides of the home. There are no pools, hot tubs or any other bodies of water present during today's inspection. 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 children in care during today's inspection. There is a 3A40BC fire extinguisher, working carbon monoxide detector, pull down fire alarm, and working smoke detectors.
Per licensee, there are no firearms in the home. All required licensing documents are posted and visible for public review. The licensee's Pediatric CPR/First Aid certificate is current and expires 8/26/25 and Lailoma's is current and expires on 10/7/25. Licensee's mandated reporter training was completed on 7/24/23 and assistant Lailoma Sarag's was completed 12/1/22. Licensee and assistant Lailoma are in compliance with the immunization law. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 11/20/23.
The Licensee is reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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: RAHIMI, HAFSA
FACILITY NUMBER: 013422602
VISIT DATE: 02/27/2024
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Licensee is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.



To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

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.

See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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: RAHIMI, HAFSA
FACILITY NUMBER: 013422602
VISIT DATE: 02/27/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

LPA discussed the safe sleep regulations with licensee Hafsa Rahimi and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed licensee Hafsa Rahimi 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.

During the exit interview, the Licensee Hafsa Rahimi confirmed that there are no Registered Sex Offenders living in the facility.

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

No deficiencies today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Hafsa Rahimi.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC809 (FAS) - (06/04)
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