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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701079
Report Date: 03/08/2024
Date Signed: 03/08/2024 11:29:12 AM

Document Has Been Signed on 03/08/2024 11:29 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:MOQIM, SONIAFACILITY NUMBER:
015701079
ADMINISTRATOR:MOQIM, SURAYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 300-4609
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/08/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Applicant, Sonia MoqimTIME COMPLETED:
11:45 PM
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Licensing Program Analyst (LPA) Jyoti Saini conducted a scheduled pre-licensing inspection today, arriving at 9:00 am and meeting with Applicant Sonia Moqim. LPA and Applicant inspected the entire house for Health and Safety Hazards. The Applicant rents this property. The double-story home has a Living room, Family room, kitchen, dining room, four bedrooms, 2.5 bathrooms, a laundry room, and a loft. A mother-in-law suite on the ground floor consists of a living room, bedroom, and bathroom. The mother's lawsuit also included a separate entrance through the backyard door. The Applicant plans to operate from 7:00 am to 6:00 pm Monday through Friday. The facility has an approved fire clearance from the Dublin Fire Department. Per fire clearance, the second floor and garage are always off-limits.
On-limit areas: The ground floor includes the living room, family room, kitchen, dining room, half bathroom, and backyard.
Off-limit areas: The entire second floor, the mother-in-law suite, the garage, and the left side of the side yard of the backyard.
The home appears neat and clean, with heating and ventilation for safety and comfort. The ISOLATION AREA will be the family room. All off-limit areas are properly barricaded. The home has a working smoke and carbon monoxide detector, a working telephone, a fully charged Fire Extinguisher, and a fully stocked First Aid Kit. No pools, hot tubs, or other bodies of water are on the premises during the inspection. A pet dog is kept in the house's off-limit area. A child safety gate is located at the bottom of the stairs to prevent access to the stairs and upper levels for children in care. LPA also discussed the 15-minute sleep check requirement during the inspection. The Applicant has a Preventive Health and Safety Training certificate, including a lead poisoning prevention update. The Applicant will be providing snacks and meals. Applicant's First Aid/CPR certificate expires on 07/2025 . Mandated Reporter training certificates are current and expire on 07/2025. The Applicant is reminded that NO walkers, exersaucers, jumpers, bouncers, or similar items are to be used for children in care and shall be made inaccessible. The Applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.
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SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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: MOQIM, SONIA
FACILITY NUMBER: 015701079
VISIT DATE: 03/08/2024
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Applicant states discipline policy is redirection/talking. Per Applicant, she may or may not purchase liability insurance, she was advised to use form, the Affidavit regarding liability insurance for FCCH. Licensee was advised to post the License when she receives it. Applicant was also advised to conducts fire/disaster drills once every six months, and to log the date and time of the drill.

LPA reviewed with applicants the LIC 311D, Forms/Records to Keep in Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicants.

APPLICANT RENTS THE HOME HAVE LANDLORD CONSENT:



The applicant provided proof of control of property

APPLICANT KNOWS PROSPECTIVE CLIENTS WILL NEED IMS:


This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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

Safe Sleep :LPA discussed the safe sleep regulations with applicants 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 applicant, 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.

Applicants was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MOQIM, SONIA
FACILITY NUMBER: 015701079
VISIT DATE: 03/08/2024
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Applicant was informed of the MyChildCarePlan.org site, 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.


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-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA received an updated emergency disaster plan and facility sketch during the inspection



Large Family Child Care home license is recommended effective, 03/08/2024.


Exit interview conducted and report was reviewed with the applicant, Sonia Moqim.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC809 (FAS) - (06/04)
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