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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100810
Report Date: 11/15/2021
Date Signed: 11/15/2021 01:51:23 PM

Document Has Been Signed on 11/15/2021 01:51 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:YOUSIF, RITA & ALJAZRAWI, KHALIDAH FCCFACILITY NUMBER:
376100810
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/15/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Applicant, Rita Yousif TIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA), Jennifer Lott, conducted an announced Pre-Licensing Inspection. LPA was greeted at the front door by Applicant, Rita Yousif and granted entry after identifying herself and disclosing the purpose of her visit. The applicant has applied for a capacity of eight (8). The home consists of three bedroom and one bath. The applicant will be using the following areas for daycare: LIving room, bathroom and front yard. Off limit areas include: Bedrooms 1-3 and backyard. There is no attached garage to the unit. Outdoor play area is fenced and locked but with constant supervision. Business Hours are Monday through Saturday 8am-5pm. Closed on Sundays. An overall inspection of the home was conducted. The inspection included, but was not limited to:

The home has a functioning carbon monoxide, smoke detector and fire extinguisher that meet statutory requirements. There are no fireplaces or open faced heaters in the home. Storage areas for poisons, detergents, cleaning solutions, medications and items which state keep out of reach of children have been locked and are inaccessible to children. There are no bodies of water on the premises. Applicant, Yousif advised there are no firearms or ammunition stored on the premises. The home is kept clean with heating and ventilation for safety and comfort. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. The home provides safe toys, play equipment and materials.

The new provider packet was reviewed with the applicant including information on children’s records, immunizations, child abuse reporting, car seat laws, shaken baby syndrome, SIDS, safe sleep and the effects of lead poisoning. Also included was information on Incidental Medical Services and the YMCA Resource Center. Applicant stated they have enough financial resources to sustain the license.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2021
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: YOUSIF, RITA & ALJAZRAWI, KHALIDAH FCC
FACILITY NUMBER: 376100810
VISIT DATE: 11/15/2021
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Applicant Yousif was also reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall not be permitted during daycare operation. All equipment that is used should be used only as intended by the manufacturer. Applicant Yousif states they are aware that interference with a child’s daily functions, physical or mental abuse and corporal punishment is not permitted. LPA and applicant discussed California Megan’s Law and LPA provided the link www.meganslaw.ca.gov.

LPA discussed safe sleep regulations with licensee or facility representative and discussed 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 licensee/facility representative 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 CPSC to be notified of any recalls on their purchased equipment

LPA discussed the following with the applicant: Maximum capacity for a small family child care home; 4 infants only (infants defined as children under 24 months) or 6 children with no more than 3 infants; or with landlord consent, 8 children with no more than 2 infants – 1 child in kindergarten or elementary school and 1 child at least age 6 including children under the age of 10 who reside in the applicant’s home.

All individuals subject to a criminal record review have obtained a clearance and/or an exemption prior working, residing or volunteering in the home. The applicant was reminded that all adults 18 years and over living or working in the home, including employees or 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 maximum per day/per person will be assessed if there is regulation is violated. The applicant has completed training on preventive health practices including pediatric CPR and First Aid. Immunizations were reviewed and are in compliance. There is a working telephone and email address.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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: YOUSIF, RITA & ALJAZRAWI, KHALIDAH FCC
FACILITY NUMBER: 376100810
VISIT DATE: 11/15/2021
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LPA provided the applicant with the following: Child Care Advocates email address of childcareadvocatesprogram@dss.ca.gov.

This facility plans to provide Incidental Medical Services (IMS). For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

The following items will need to be corrected prior to the issuance of the license: Purchase of a touchless thermometer, first aid kit, paper plates and utensils. Once all corrections have been made, and proof has been received in the licensing office, a license for eight (8) children will be granted pending final file review. Applicant agreed to comply with all regulations and laws governing Family Child Care Homes. Additional Technical Assistance was provided and noted on the attached Advisory Note – Technical Assistance (LIC 9102).

An exit interview conducted and report was reviewed with applicant, Yousif. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
LIC809 (FAS) - (06/04)
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