344500710-10-27-2022-53-CC-SMAY-CKLTDG-20221027143820

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500710
Report Date: 10/27/2022
Date Signed: 10/27/2022 02:38:31 PM

Document Has Been Signed on 10/27/2022 02:38 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:	AHMED, SHABANA		FACILITY NUMBER:	344500710
ADMINISTRATOR:	AHMED, SHABANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 271-7575
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/27/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Shabana Ahmed		TIME COMPLETED:	01:55 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 Analysts (LPAs) Salene Mayberry and Corina Beckby met with Applicant, Shabana Ahmed for the purpose of a prelicensing evaluation. Applicant's tentative hours are Monday - Friday from 6:30 am to 6:00 pm. A fire clearance was granted by Consumnes Community Services District Fire Department on September 26, 2022. Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. A health and safety inspection was conducted inside and out. The one-story home has 3 bedrooms and 2 bathrooms. LPAs toured all rooms in the home and verified all knives and toxic and/or hazardous items were inaccessible to children in care. A First Aid kit is stored in the pantry. Functioning smoke and carbon monoxide detectors were observed, as well as a 2A10BC fire extinguisher. LPAs observed a fireplace in the home that is properly barricaded. Applicant stated there are no weapons in the home. Outdoor play area was toured. The yard is completely fenced in and there are no bodies of water on the premises. The OFF-LIMIT areas in the home are: the master bedroom/bathroom, son’s bedroom, laundry room and garage. Off-limits areas will remain inaccessible to children by closed doors, gates, supervision. LPAs discussed the requirement to renew the mandated reporter training every two years and provided the Mandated Reporter training website: www.mandatedreporterca.gov. Applicant was reminded that all licensed providers and employees must complete this training, and that volunteers are encouraged, but not required to take the training. Report Continued on LIC809-C.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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: AHMED, SHABANA	FACILITY NUMBER: 344500710
	VISIT DATE: 10/27/2022

NARRATIVE

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LPAs verified Applicant has a current Mandated Reporter Training Certificate that expires 2/18/2024. LPAs also verified pediatric CPR and First Aid training was current and expires 2/2024.

The Incidental Medical Services (IMS) policy was discussed. Applicant understands that when any IMS is provided, a written plan 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

LPAs discussed the requirement to check and log infants napping every 15 minutes, for all infants under 24 months. LPAs also provided a copy of LIC9227 Individual Sleeping Plan, which must be completed and placed in all files for infants under 12 months.
LPAs then provided 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.

LPAs also informed Applicant 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.

LPAs reviewed with Applicant the LIC311D Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Applicant understands that assistant and children’s records are to be maintained according to Title 22 regulations and must be accessible to Licensing for up to three years from the date of unenrollment.

Applicant acknowledges that if an unusual incident occurs; Licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report (LIC624) shall be submitted within 7 days to remain in compliance.

Report Continued on LIC809-C.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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: AHMED, SHABANA	FACILITY NUMBER: 344500710
	VISIT DATE: 10/27/2022

NARRATIVE

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Applicant understands that licenses are not transferable, and once licensed, they must live in the home and be present for 80% of the operating hours.

Applicant also understands that if any structural changes are made to the home Licensing must be notified prior to construction. LPAs discussed, and Applicant acknowledges, that if they want to make any OFF-limit area ON-limits, they must notify Licensing and an inspection must be completed BEFORE children are allowed in the area.

LPAs discussed with Applicant that Community Care Licensing Division (CCLD) regularly sends information to licensed facilities and providers by way of Provider Information Notices (PINs) and Program Quarterly Update Newsletters. To receive important license related information LPAs encouraged Applicant to visit the CCLD “Important Information website” at
https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the “Child Care” option to receive email communications. Finally, Applicant was also encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

An Exit interview was conducted, and the report was reviewed, and a copy provided to Applicant. As of today, October 27, 2022, Applicant is approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without an assistant, the ratios revert to those for Small Family Child Care Home.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

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