343625153-10-3-2023-03-CC-MGAO-CW9NVT-20231003104828

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625153
Report Date: 10/03/2023
Date Signed: 10/03/2023 10:48:37 AM

Document Has Been Signed on 10/03/2023 10:48 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:	AL HASSANY, ZAINAB		FACILITY NUMBER:	343625153
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/03/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Zainab Al Hassany		TIME COMPLETED:	10:55 AM

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	At 9:00 am, Licensing Program Analyst (LPA) Matthew Gallo met with applicant Zainab Al Hassany for the purpose of a prelicensing inspection. Applicant has requested a Small Family Childcare Home License to serve up to eight children. The facility is a two story home with a second, unattached converted garage. The first floor of the home consists of a living room, kitchen, dining room, office, bathroom, bedroom, laundry room, and garage. The second floor consists of 3 bedrooms and 2 bathrooms and small storage space. There is also a converted unattached garage on the property that is currently used for storage. Off limit areas include: lower bedroom, laundry room, garage, all upstairs, and converted unattached garage. Licensee understands that children must never enter these areas. Backyard is fenced. Intended hours of operation will be 8:00AM-5:00PM, Monday thru Friday. Applicant understands they must be present at the facility for 80% of operating hours. Applicant understands that their own children under 10 years old count toward the ratio. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant's husband currently is working abroad for the military, and licensee understands that he must submit fingerprints and receive criminal background clearance within 30 days of his return. Applicant was reminded that all adults 18 and over living or working in the home, 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 5 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. Continued on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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: AL HASSANY, ZAINAB	FACILITY NUMBER: 343625153
	VISIT DATE: 10/03/2023

NARRATIVE

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LPA and applicant toured the entire facility. LPA observed functioning smoke and carbon monoxide detectors and a 2A10-BC fire extinguisher. Applicant keeps cleaning materials in cabinet under kitchen sink which requires a lock. A lock is also needed for the kitchen drawer containing sharp knives. Applicant stated that there are no firearms in the facility, and LPA observed no bodies of water on the property. Poisons are currently stored in unattached garage, which applicant understands must remain locked at all times during day care hours. There are three stairways in the home, only one of which is currently fenced properly. There is a fireplace in the living room for which applicant has requested a waiver. LPA reviewed required postings with applicant.

Applicant provided proof of control of property. Applicant understands that until a liability insurance coverage in the amount of $300,000 is provided, the affidavit form LIC282 form will be used.

Applicant submitted proof of current CPR/First Aid (exp 8/2025), AB1207 Mandated Reporter certificate (exp 7/2025), and completed Preventative Health and Safety Training. Applicant understands the CPR/First Aid and Mandated Reporter training must be renewed every two years.

LPA reviewed Safe Sleep regulations and provided the 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 licensee 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.

Incidental Medical Services was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417 and when any IMS is provided, an updated Plan of Operation that includes 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) 513-0301 (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.ht

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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: AL HASSANY, ZAINAB	FACILITY NUMBER: 343625153
	VISIT DATE: 10/03/2023

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This facility evaluation report was reviewed and discussed with the applicant. 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 childcare updates, forms, regulations and legislation pertaining to family childcare homes.

The following corrections need to be made prior to approving a Small Family Child Care Home license:
-Locks need to be added to cabinets/drawers with cleaning chemicals and sharp knives
-All three stairways in the home need to be properly fenced

Applicant will send pictures of corrections to LPA Gallo.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC809 (FAS) - (06/04)

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