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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624962
Report Date: 09/14/2023
Date Signed: 09/14/2023 03:26:57 PM

Document Has Been Signed on 09/14/2023 03:26 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ABDULHAMEED, SAMARFACILITY NUMBER:
343624962
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
09/14/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Samar AbdulhameedTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Kyrsten Williams met with Licensee Samar Abdulhameed for the purpose of an unannounced case management inspection. Licensee has requested to increase from a small family childcare to a large family childcare. All individuals subject to criminal background review have obtained a criminal record clearance. LPA observed two children present during today’s inspection.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include garage, master bedroom, and master bathroom. Licensee acknowledges that she must contact Community Care Licensing prior to making an off-limit area on-limits and vice versa. A fire clearance was granted on 09/07/2023.

LPA discussed CCR Regulation 102416.5 regarding staffing Ratio and Capacity for a large license.

LPA discussed personnel requirements and records outlined in CCR Regulations 102416 and 102416.1.

Licensee understands that when an assistant is not present, she must comply with the capacity and ratio requirements for a Small Family Child Care Home.

Effective today, 09/14/2023, the facility is approved for a large capacity to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years.

This facility evaluation report was reviewed and discussed with the licensee Samar Abdulhameed. A Notice of Site Visit was provided and should remain posted for 30 days for parental review.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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