304314219-11-25-2024-06-CC-CNGN-DBCTTH-20241125140047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314219
Report Date: 11/25/2024
Date Signed: 11/25/2024 02:01:08 PM

Document Has Been Signed on 11/25/2024 02:01 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	BOSHRA, REHAM		FACILITY NUMBER:	304314219
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 6	CENSUS: 6	DATE:	11/25/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:00 PM
MET WITH:	Licensee, Reham Boshra		TIME VISIT/ INSPECTION COMPLETED:	02:30 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), Cindy Nguyen conducted an unannounced case management inspection due to licensee's request to increase license capacity from small family child care home to large family child care home. Fire clearance from the Orange County Fire Authority was received and approved for a large family child care home on 11/13/24. The regulations for Large FCC Home were reviewed. LPA toured the facility with licensee, Reham Boshra. Present during today's inspection was the licensee, an assistant, licensee's daughter, one infant and five preschool day care children. Currently there is four adults including the licensee and one minor child living in the home. Day care hours are 7:30am-5:00pm, Monday through Friday. A review of adults' records on today's date indicates that all adults live in the home or individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility is a 2-story home with 4 bedrooms, 1.5 bathrooms, 4 bedrooms are upstairs, 1 bathroom is upstairs and ½ bathroom is downstairs next to the front door. There is a living room, a kitchen, dining room, and a front courtyard (not fenced), backyard (fenced), and stairs leading to the second floor. The licensee has designated the living room, downstairs bathroom next to front door, kitchen, back patio, and front courtyard (not fenced), community playground as the day care areas. The entire 2^nd floor, garage, laundry room and pantry, as the off-limits areas. The licensee has a child-proof safety gate at the bottom of the stairs to the 2^nd floor, ensuring the 2^nd floor is inaccessible to children in care. Licensee has placed child-proof locks on closets in the entryway of front door, and in the latch and key. Licensee acknowledged the children may never enter the off-limit areas. There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Page 1 of 3

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BOSHRA, REHAM	FACILITY NUMBER: 304314219
	VISIT DATE: 11/25/2024

NARRATIVE

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Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspections. The home has age-appropriate toys for the ages served. LPA verified there is a working cellular service. Outdoor play activities is in the patio area. The patio is appropriately fenced. LPA observed age-appropriate play equipment to be free from hazards. There are 2 community playgrounds that licensee use for activities that is a 5-minute walk from licensee’s house. LPA went over 100% supervision with children at all times. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible. There is a community pool that is about 20 feet away from the first playground next to the club house. That applicant states she will not be using it for the day care children.

LPA observed CPR & First Aid (exp. 10/26) are current for the licensee. Current immunization information and mandated reporter training were verified by LPA.

The following were discussed: Individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to being present in the facility. Adults must contact a Live-Scan complete LIC 9163. If adult is fingerprinted cleared and associated to another facility, licensee must complete a Criminal Record Clearances or Exemption Transfer Request form (LIC 9182). Contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182 or LIC 9188) with copy of ID and Criminal Record Statement (LIC 508) to fax # (714)703-2831 prior to hiring adult.

LPA advised licensee to contact licensing for any changes to hours and days of planned operation, and for any changes to facility, including on/off limit areas and change in phone number. The licensee has a cell phone that is used for child care. The licensee was reminded that if a cell phone is only used, it must remain on the premises always during hours of operation. Licensee was reminded and understands the home is to be free from smoking always.

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.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BOSHRA, REHAM	FACILITY NUMBER: 304314219
	VISIT DATE: 11/25/2024

NARRATIVE

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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/childganda.htm.

CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates.

Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The home was in compliance with Title 22 Regulations. LPA informed licensee that a final review of the file will be done before the large family child care license is issued. The licensee will be notified if any corrections or additions need to be completed. Pending review and approval, a large family child care license will be granted.

Inspection report review and exit interview was conducted. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. First level should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. Page 3 of 3

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 11/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024

LIC809 (FAS) - (06/04)

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