Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422344
Report Date: 03/21/2018
Date Signed 03/21/2018 12:09:45 PM

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:HABIB, RAQUELFACILITY NUMBER:
013422344
ADMINISTRATOR:HABIB, RAQUELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 573-1320
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:14CENSUS: 6DATE:
03/21/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Raquel HabibTIME COMPLETED:
12:20 PM
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Licensing Program Analyst Briana Plumboy, met with licensee Raquel Habib for an UNANNOUNCED REQUIRED 3 YEAR INSPECTION. Present for this visit was licensee's fingerprint clear husband/assistant Syed Habib, 3 infants, and 3 preschool age children. The home was toured to conduct a Health and Safety Inspection.

The home is single story. The home appears to be neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, family room #1 next to the living room, bathroom in the hallway where the bedrooms are located and a sectioned off portion of the backyard outside of family room #2. The OFF LIMIT AREAS are all bedrooms, family room #2, kitchen, bathroom next to the kitchen, bathroom in the family room #2, sectioned off area of the backyard around the outdoor play space, laundry room and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the right corner of the living room separated from the children in care. . The BACKYARD play area is free from defects or dangerous conditions and is completely fenced. Outdoor play area will be a sectioned portion next to family room #2 There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water. 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 today.
The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone, and fully stocked First Aid Kit. Raquel and Syed Habib both have current CPR/First Aid certificates which are current and expires 07/09//2018. The home has centralized heating. There are no fireplaces or wall heaters. 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 03/08/18.

(3) Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review.
SEE 809-C
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: 510-286-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2018
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HABIB, RAQUEL
FACILITY NUMBER: 013422344
VISIT DATE: 03/21/2018
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Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

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

LPA informed licensee of Assembly Bill 1207, the mandated reporter training which can be found at www.mandatedreporterca.com.



For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

No deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: 510-286-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2018
LIC809 (FAS) - (06/04)
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