343625082-9-20-2023-03-CC-JVEO-CVUPQ8-20230920113044

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625082
Report Date: 09/20/2023
Date Signed: 09/20/2023 11:30:54 AM

Document Has Been Signed on 09/20/2023 11:30 AM - 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:	BAKUR, MAYADA		FACILITY NUMBER:	343625082
ADMINISTRATOR:	BAKUR, MAYADA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 661-9226
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/20/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Mayada Bakur		TIME COMPLETED:	12:00 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 Jennifer Velasco (LPA) met with Applicant Mayada Bakur (L1) to conduct an announced Pre-Licensing inspection for this new facility. L1 was formerly licensed at a different location and closed the previous facility. LPA toured L1's home. Licensee provided proof of control of property. L1 stated the facility hours will be Monday - Friday, 7:00 AM – 5:30 PM. L1 stated at this time she does not plan to provide care to infants, who are children under two years old. L1 stated she understands that if she decides to start providing care to infants, she needs to notify the Department. L1 was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. On 09/12/2023, the California Attorney General - Megan's Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. Off-limit areas will consist of: Left side yard, guest room, dining room, living room, kitchen, second floor, gated stairs from family room to the rest of the home, garage, and outbuilding. L1 understands that children may never enter the off-limit areas. L1 acknowledges she is required to notify Licensing prior to making changes to the home or yard so that they may be inspected for safety. LPA observed a functioning smoke and carbon monoxide detector and 2A-10-BC fire extinguisher. Children will enter the home through the side gate on the east side of the home and will receive care in the family room, adjoining powder room and fully fenced backyard. Page one of three

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BAKUR, MAYADA	FACILITY NUMBER: 343625082
	VISIT DATE: 09/20/2023

NARRATIVE

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Hazardous cleaning products and chemicals, knives, and medications are all stored inaccessible to children. L1 understands that poisons must be locked. The backyard is fenced. LPA advised L1 in areas that are not fenced, 100% supervision must be maintained at all times. L1 stated she does not have any firearms and LPA did not observe any bodies of water.

LPA reviewed with Licensee LIC 311 D, Forms/Records to Keep In Your Family Child Care Homes, children's forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. L1 has a current pediatric CPR/First Aid certificate and has completed the preventative health and safety course. L1 has completed the Mandated Reporter training and has provided proof of immunizations. L1 was reminded that the CPR/First Aid and Mandated Reporter certificates must be updated every two years. LPA obtained proof that the L1 lives in the home. L1 understands that if she does not have liability insurance, she will have parents fill out an affidavit.

LPA reviewed current COVID-19 guidelines, postings, and protocols. LPA reviewed Type A and Type B citations, Zero Tolerance, and Civil Penalties. LPA reviewed open door policy, supervision, fire drills, children’s personal rights, reporting requirements, and the smoking prohibition with the L1. A current roster of children enrolled must be available and maintained for a period of three years after children are no longer in care. LPA went over requirements for an assistant. LPA reminded L1 that annual fees must be paid promptly and by the due date or late fees will be assessed. LPA advised L1 that she has the option to put her home on Inactive Status at any time for up to a year while continuing to pay fees.

LPA discussed with L1 the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed L1 of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BAKUR, MAYADA	FACILITY NUMBER: 343625082
	VISIT DATE: 09/20/2023

NARRATIVE

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Licensee stated food allergies will be monitored and any allergenic foods will not be offered. Licensee will decide what meals she may provide along with snacks and will notify the Department when she decides.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN) and Program Quarterly Update Newsletters. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication. Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the Applicant, Mayada Bakur. A notice of site visit was given to Applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

As of today’s date, DATE, Applicant must complete the following task(s) and submit documentation of completion to LPA via email to meet the requirements for licensure. Once LPA has received documentation of completion of any/all tasks, LPA will process approval of the license.
1. All adults in the home must be cleared and associated to the facility.
2. Approved fire clearance must be provided to Department

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC809 (FAS) - (06/04)

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