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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623869
Report Date: 03/19/2021
Date Signed: 03/19/2021 04:20:31 PM

Document Has Been Signed on 03/19/2021 04:20 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ABOU REBIEH, SANAAFACILITY NUMBER:
343623869
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
03/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sanaa Abou RebiehTIME COMPLETED:
12:00 PM
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NOTE: Due to COVID19 pandemic and DPH guidelines on physical distancing, a Tele-visit via WhatsApp is being conducted.

Licensing Program Analyst (LPA) Marea Behvand met with Applicant Sanaa Abou Rebieh for the purpose of an announced pre-licensing tele-inspection. Also present during the inspection were Applicant's spouse, adult children, and minor child. All individuals subject to criminal background review have obtained a criminal record clearance.

A health and safety inspection was conducted inside and out. The one story home consists of Master Bedroom #1 and ensuite bathroom, Bedroom #2, Bedroom #3, hall bathroom, kitchen, living room, dining room, garage, and backyard. Applicant requested to make Master Bedroom and en-suite bathroom and garage off-limits. LPA reminded Applicant that any off-limits areas will remain inaccessible to children by closed doors and/or supervision. Applicant acknowledges that LPA must be contacted prior to making an off-limits area on-limits and vice versa. Toxic and hazardous items are out of reach and inaccessible to children. A functioning smoke detector, carbon monoxide detector, and a 2A10BC fire extinguisher were observed. The home has a fire place that was properly screened. Applicant stated licensing documents will be posted on the wall upon entry.

Preventative Health and current in-person EMSA pediatric CPR and First Aid certification was verified and expires 01/09/2023. Applicant was encouraged to maintain supervision at all times. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed.

Report continues on 809-C.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Marea Behvand
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ABOU REBIEH, SANAA
FACILITY NUMBER: 343623869
VISIT DATE: 03/19/2021
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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

This facility evaluation report was reviewed and discussed with the applicant. LIC 311D, records, postings, and reporting requirements were discussed. LPA discussed supervision, personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided to Applicant by email transmission the Safe Sleep in Child Care and the Effects of Lead Exposure brochures. LPA also emailed all required licensing forms. LPA informed Applicant that prior to her providing care for any child that she would need to have a file for the child containing all the required forms filled out by the parents.

Effective today, Friday March 19, 2021 this facility is approved for a small family child care home license that has a max capacity of 6 children with no more than 3 being infants, or with 4 INFANTS ONLY.

With landlord consent, the facility may have a max capacity of up to 8 children with no more than 2 infants, with 1 child to be in Transitional Kindergarten or above and 1 child to be at least 6 years of age or older.

Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Marea Behvand
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC809 (FAS) - (06/04)
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