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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100671
Report Date: 08/11/2021
Date Signed: 08/11/2021 03:44:53 PM

Document Has Been Signed on 08/11/2021 03:44 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ALKHAWRI, SUHA FAMILY CHILD CAREFACILITY NUMBER:
376100671
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
08/11/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Suha AlkhawriTIME COMPLETED:
03:50 PM
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On 08-11-21 at 1:30 PM, Licensing Program Analyst’s (LPA’s) LeAndra Dolliole and Keturah Lane, conducted an announced Change of Location Inspection. LPA’s met with applicant Suha Alkhawri. The 3 Bedroom, 2 Bathroom one story home, was toured and inspected to ensure an environment safe for the care and supervision of children.

The fire extinguisher located in the kitchen, carbon monoxide detector located in the kitchen and smoke detector located in the hallway and bedroom 1 meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There is a fenced pool in the backyard that meets title 22 regulations, applicant is aware that supervision is required at all times when in the pool area. Applicant stated the Backyard and pool will be off limits and will not be used while children are in care.

Applicant states that there are no weapons in the home. Applicant states that they have sufficient financial resources to sustain the license. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Applicant owns the home and has provided proof of control of property. Applicant understands that, at this time the applicant may care for up to 8 children.

First Aid and CPR expire in August of 2022 and preventative health course was completed. Lead Poisoning Prevention Training was completed in March 2021. The Mandated Reporter Training was completed in April 2021.Staff immunization requirements were met.
The applicant has toys and equipment available. Required documents have been posted. Applicant will be using the following rooms for childcare: Living Room, Dining Area, Kitchen, Bedroom 1 and Bathroom1.
Report Cont. on ...809C
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Leandra Dolliole
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ALKHAWRI, SUHA FAMILY CHILD CARE
FACILITY NUMBER: 376100671
VISIT DATE: 08/11/2021
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The following areas will be off limits: Bedroom 2, Bedroom 3, Bathroom 2, Garage, Backyard and Pool. Off-limits are inaccessible by use of doorknob covers and applicant stated she will install an additional lock to the sliding glass door that leads to the backyard and pool area. Applicant stated they will be using the front yard for outdoor play and activities. Applicant will provide visual supervision during outdoor play at all times.

The new provider packet was reviewed with the applicant including information on child abuse reporting, children’s records, immunizations, adults living or working in the home, SIDS, Incidental Medical Services, ratios, capacity and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and applicant discussed Shaken Baby Syndrome and California Megan's Law and LPA provided: www.meganslaw.ca.gov. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress. Applicant was provided COVID-19 resources and directed to website: www.ccld.ca.gov to receive important updates and information.

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 discussed and provided applicant with the following information:
· Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov.
· For common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.
The following corrections are needed, Sliding Glass door leading to backyard needs an additional lock to ensure it is off-limits to the children. Upon receipt of photos and video footage of sliding door lock, a license for 8 children will be granted upon final file review. Applicant agreed to comply with all regulations and laws governing family child-care homes.
An exit interview was conducted with applicant. Appeal Rights (LIC9058) were given with the report (LIC809). Signature on the report acknowledges their receipt of these rights.


SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Leandra Dolliole
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC809 (FAS) - (06/04)
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