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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100875
Report Date: 10/19/2021
Date Signed: 10/19/2021 02:38:20 PM

Document Has Been Signed on 10/19/2021 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HAMDARD, KHALID FAMILY CHILD CAREFACILITY NUMBER:
376100875
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Khalid HamdardTIME COMPLETED:
02:40 PM
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Licensing Program Analysts (LPAs), Tyra Block and Daniel Pena, conducted an announced Pre-Licensing inspection with the applicant. The single story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher (2A10BC), 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 are no bodies of water in the home. Applicant states that there are no weapons in the home. Applicant has certified 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 rents the home and has provided proof of control of property. First Aid and CPR expire on 10/2023 and preventative health practices course was completed on 9/9/21. Mandated Reporter Training was completed on 7/12/21 . Staff immunization requirements were met.

Applicant will be using the following rooms for childcare: Living Room, Kitchen, Bathroom #2 and Bedroom #2. The following areas will be off limits: Master Bedroom, Bedroom #3, and backyard. The bedrooms are inaccessible through the use of doorknob covers and the backyard will be made inaccessible through lock on sliding glass window and barricade to a small section. The applicant has sufficient toys and equipment available for children to use. The front yard is available for outdoor activities. Supervision is to be maintained when outdoors.

The New Provider Resource Packet was reviewed with the applicant including information on the following: SIDS, shaken baby,liability insurance, child abuse reporting, community resources, children’s records, facility records, required postings, immunization's, unusual incident report, roster, car seat law, visual for ratio/capacity, fire/disaster drill log and effects of lead exposure. Applicant was also informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care. LPA and Applicant discussed Safe Sleep, California Megan's Law and LPA provided: www.meganslaw.ca.gov.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2021
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: HAMDARD, KHALID FAMILY CHILD CARE
FACILITY NUMBER: 376100875
VISIT DATE: 10/19/2021
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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.

Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.Southern California Child Care Advocate information was provided and applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

A license for 8 children will be issued effective today, 12/30/20. Applicant is aware that Landlord Consent (LIC 9149) and Parent Notification Additional Children in Care (LIC 9150) is required if caring for more than 6 and up to 8 children.

The applicant was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
LIC809 (FAS) - (06/04)
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