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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100857
Report Date: 10/01/2021
Date Signed: 10/01/2021 01:04:08 PM

Document Has Been Signed on 10/01/2021 01:04 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:AL SAMMARIE, ZAINAB FAMILY CHILD CAREFACILITY NUMBER:
376100857
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/01/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Zainab Al SammarieTIME COMPLETED:
01:15 PM
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On 10/1/21 Licensing Program Analyst (LPA) Michael Morales-DeSilvestore conducted an announced change of location inspection with the applicant. The 4 bedroom, 3 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Applicant states that operating hours are Monday-Sunday, 4AM to 1AM.

The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There is a jacuzzi in the backyard that needs a locking cover. 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 owns the home. First Aid and CPR expire on June 2023 and preventative health practices course was completed on 9/24/21. Mandated Reporter Training AB 1207 was completed on 9/9/21 and the licensee is reminded to retake the course every 2 years. Staff immunization requirements per SB792 were met.

Applicant will be using the following rooms for childcare: Room 1, Room 2, Room 3 and bathroom 1. The following areas will be off limits: Kitchen and entire upstairs. The garage will also be off limits and is kept inaccessible through the use of a dead bolt and door knob cover. The applicant has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities.

Provider is reminded to adhere to all applicable laws and regulations. The laws and regulations can be found on the Department of Social Services website:
https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers/laws-and-regulations
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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: AL SAMMARIE, ZAINAB FAMILY CHILD CARE
FACILITY NUMBER: 376100857
VISIT DATE: 10/01/2021
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Applicant was reminded of requirements for children’s records, child abuse, and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA provided information regarding Safe Sleep Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

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.

The following corrections are needed prior to issuance of the license; Locking jacuzzi cover, pebbles in the fountain and proof of proper wall postings.

Licensee will need to complete all corrections by 10/30/21

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC809 (FAS) - (06/04)
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