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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407425
Report Date: 09/21/2022
Date Signed: 09/21/2022 06:16:33 PM

Document Has Been Signed on 09/21/2022 06:16 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BABY YALE ACADEMYFACILITY NUMBER:
073407425
ADMINISTRATOR:MUAZZAMA(AFRIN) QURASHYFACILITY TYPE:
830
ADDRESS:5521 LONE TREE WAYTELEPHONE:
(925) 308-7693
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 66TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
09/21/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Muazzama Afrin QurashyTIME COMPLETED:
06:30 PM
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Licensing Program Analysts (LPA) Cherie Acosta and Christina Watts conducted an unannounced Case Management Inspection. LPAs met with Muazzama Afrin Qurashy.

LPAs arrived at the facility to investigate complaints on the preschool and school age programs. LPAs toured the facility. In the infant room at approximately 1:35 LPAs observed an infant sleeping with a toy in the crib which is a violation of California Code of Regulations, title 22.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

This is a repeat violation. The facility was previously cited 6/2/22 for an infant sleeping with a blanket. A civil penalty of $250.00 is assessed today.

Exit interview and report reviewed with Muazzama Afrin Qurashy.
Notice of Site Visit was provided and must be posted for 30 day.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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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Document Has Been Signed on 09/21/2022 06:16 PM - It Cannot Be Edited


Created By: Cherie Acosta On 09/21/2022 at 01:57 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: BABY YALE ACADEMY
FACILITY NUMBER: 073407425

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/22/2022
Section Cited
CCR
101439.1(f)

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Infant Care Center Sleeping Equipment. Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement was not met as evidenced by: Infant was sleeping with a toy in the crib which poses
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Director shall develop a plan of action to ensure nothing in placed in the sleeping area of infants. Director shall submit a copy of this plan to CCL by 9/22/22
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an immediate risk to the health and safety of children in care
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• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022


LIC809 (FAS) - (06/04)
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