274417474-8-1-2025-07-CC-SBAR-DK5RFW-20250801125950

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274417474
Report Date: 08/01/2025
Date Signed: 08/01/2025 01:00:05 PM

Document Has Been Signed on 08/01/2025 01:00 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	HAMDARD, ARZO		FACILITY NUMBER:	274417474
ADMINISTRATOR/ DIRECTOR:	ARZO HAMDARD		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 388-9573
CITY:	MARINA	STATE: CA	ZIP CODE:	93933
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	08/01/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:48 AM
MET WITH:	Arzo Hamdard		TIME VISIT/ INSPECTION COMPLETED:	01:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Syeda Bahar met with the Applicant, Arzo Hamdard, and her spouse Erfanullah Arsala for an announced Pre-Licensing Inspection, for a change of location. In addition to applicant and her spouse, present for this inspection are three fingerprint cleared adults and two minor children, aged 17 years and 12 years old. The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are, Monday – Friday, 6:00 AM – 6:00PM. The family day care is a two-story family home. The home consists of a living room, family room, dining area, kitchen, five (5) bedrooms, three (3) bathrooms, garage, and backyard. The home is neat and clean with heating and ventilation for safety and comfort. LPA observed the stairs inside the home is barricaded. On-limits: The On-limits areas on the first floor are, the Living room, Family room, Dining Area, Kitchen, one Bathroom in the hallway, and Backyard. Off-limits area: Entire upstairs, One downstair Bedroom, and Garage. Isolation area: Family room. During today's inspection LPA obtained an updated facility sketch, Form LIC 999A indicating the on-limits and off-limits areas. LPA observed there is a fireplace in the family room area. LPA advised the Applicant Arzo to install a barricade in front of the fireplace to make the area inaccessible to children. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The home has a First Aid kit with a touchless thermometer in the home. The outdoor play area is free from defects or dangerous conditions and fenced. *Continue to page 2*

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HAMDARD, ARZO	FACILITY NUMBER: 274417474
	VISIT DATE: 08/01/2025

NARRATIVE

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The Applicant’s CPR and First Aid certificates are current and expires in May, 2026. Applicant Arzo Hamdard’s Mandated Reporter Training is current and expires on April, 2027. The Applicant was reminded of Mandated reporter Training (AB1207), and CPR/First aid certifications need to be renewed every two years. A copy of the Applicant’s immunization record is on file. The applicant, Arzo stated that there are no firearms in the home.

LPA observed there are no sleeping equipment for the children in the home. The Applicant Arzo stated that she will purchase the sleeping equipment for the children. The applicant was reminded that all cribs or play yards must meet the safety standards. The cribs or play yards must not hinder entrance or exit to and from the space where infants are sleeping. The Applicant was reminded that the mattresses in the crib or play yards need to be firm and covered with a fitted sheet that is appropriate, fits tightly, and overlaps the underside of the mattresses. The Applicant was reminded that each infant’s bedding is used for them only and cleaned weekly or before use by another infant. Applicant was reminded that there should be no loose articles and objects, bumper guards or objects hanging above or attached to the side of the cribs or play yards. Applicant, Arzo, stated she will not administer any medication to the children at this time. The Applicant also stated that she plans to provide breakfast, lunch and snacks for the children. Per the Applicant, children will be isolated in the family room, if necessary, due to illness or communicable disease.

Forms of discipline to be used by the Applicant is to redirect the children by talking with them. The Applicant understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, children are treated with dignity, receive safe, healthful, and comfortable accommodations, interference with eating, intimidation, or other actions of a punitive nature.

The Applicant was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to Community Care Licensing Division (CCLD) by the next business day by phone. Within seven (7) days from the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. The Applicant was reminded that any structural changes or additions to the home must be reported to CCLD as well. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented.

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HAMDARD, ARZO	FACILITY NUMBER: 274417474
	VISIT DATE: 08/01/2025

NARRATIVE

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The Applicant provided proof of control of the property. LPA Syeda observed the Property Owner/Landlord Notification form (LIC 9151) that the Licensee confirms was provided to the property owner/landlord. The licensee obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Applicant, Arzo Hamdard 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.

LPA discussed the safe sleep regulations with Applicant, Arzo Hamdard, 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 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.

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) 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.

LPA reviewed with the Applicant, the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Pre-licensing Entrance Checklist – Family Child Care Homes (LIC 9280) was provided to the Applicant.

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HAMDARD, ARZO	FACILITY NUMBER: 274417474
	VISIT DATE: 08/01/2025

NARRATIVE

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On this date, 07/29/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

The 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-carelicensing/subscribe and select the Child Care option to receive email communication.

LPA advised the Applicant, Arzo Hamdard to complete the following items by August 15, 2025.

a. Install a barricade in front of the fireplace in the family room.
b. Purchase and setup Children’s sleeping equipment (crib/play yards for infants, cots/mats for older children)

Exit interview conducted and report was reviewed with the Applicant, Arzo Hamdard. Appeal rights were provided.

LPA advised the Applicant, Arzo Hamdard that a Large Family Child Care Home license will be approved pending Licensing Program Manager’s review.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Syeda Bahar
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

LIC809 (FAS) - (06/04)

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