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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623922
Report Date: 05/10/2021
Date Signed: 05/10/2021 04:33:49 PM

Document Has Been Signed on 05/10/2021 04:33 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:ALNUAIMI, ATHRAAFACILITY NUMBER:
343623922
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
05/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Athraa AlnuaimiTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Kelly met with the applicant at 2:55pm, on May 10th, 2021 via Facetime due to Covid emergency, at the home for the purpose of a change of location inspection. LPA Kelly toured the home inside and backyard. There were applicant's 2 children and husband present today.
The home is a 2 story, 4 bedrooms and 3 bath house. Off limit areas include: Entire second floor and garage. The applicants provided proof of ownership. LPA explained about obtaining $300,000 liability insurance. She understands that until a policy is obtained, she must use the affidavit. LPA provided a copy of affidavit to the applicant.
Applicant has Health and Safety certificate, also has CPR/First Aid Cards and Mandated Reporter Cert. All adults are fingerprint and child abuse cleared. Licensee stated that there are no firearms in the home. Smoke and Carbon monoxide detectors and Fire extinguisher meet Title 22 Regulation. Cleaning compounds were out of reach of children. Knives were out of reach of children. Medications are stored out of reach of children. There were no accessible hazardous materials or chemicals observed. Soaps were stored in a kitchen latched cabinet There were no hazardous materials in the children's bathroom. The backyard is fenced, and there were no bodies of water observed on the property.
LPA reviewed forms for children's records and provided copies of the forms. LPA discussed and reviewed Health & Safety code: 1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions. 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
LPA also discussed safe sleeping practices and provided a copy of the Fact Sheet-AB 633 Child Parent Notification. LPA discussed the unusual incident reporting, fingerprinting policy and TB testing requirements for adults. LPA discussed fire drills with the applicant, as well as Zero Tolerance Type A deficiencies and the immediate civil penalty imposed if cited with a Zero Tolerance Type A deficiency.

As of today's date: 5/10/21, LPA will grant a license to serve up to either 8 children, two (2) of which must be at least 6 years of age and no more that two (2) may be infants; or 6 children, three (3) of which may be infants; or 4 infants only. Infants are children under the age of 2 years.

This report was provided and emailed to be sign and return to LPA
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Socorro Kelly
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2021
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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