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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101083
Report Date: 05/31/2022
Date Signed: 05/31/2022 01:02:36 PM

Document Has Been Signed on 05/31/2022 01:02 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:ALZERKANY, METHAK FAMILY CHILD CAREFACILITY NUMBER:
376101083
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/31/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Methak AlzerkanyTIME COMPLETED:
01:10 PM
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On 05/31/2022 at 9:40am, Licensing Program Analyst (LPA), Selina Siao conducted a pre licensing inspection with applicant Methak Alzerkany. The 6 bedroom, 4 bath two stories house was toured and inspected to ensure an environment safe for the care and supervision of children. The home has an operating smoke and carbon detector that meet requirements and are operational. Not all hazardous items were latched/locked and secured out of reach of children during the inspection. The home does not have any bodies of water. Applicant stated that the home doesn't have any weapon. Applicant has an EMSA approved pediatric CPR and First Aid card that are current due to expire on 04/16/2024 and she is exempt from taking the mandated child abuse training at this time as it is not available in her native Arabic language. A review of the application and records on this date indicates that applicant, her husband and her older son are the current adult residents at the home with the require TB clearances, caregiver background checks and child abuse clearances. Applicant has the required immunizations. Applicant's husband owns the home and has provided a copy of the mortgage statement to show control of the property.
Applicant will be using the following areas located on the main floor for childcare: living room, bathroom, dining room, kitchen, family room and bonus room. Applicant stated that the bonus room will be the isolation area. Off limit areas includes: laundry room, office and the entire lower level of the home. The home has two fireplaces that needs to be blocked off to prevent children's access as it currently only has a mesh screens. Outdoor area will be the patio deck off the family room and visual supervision is required when children are outside.
Applicant was reminded of requirements for children’s records, facility roster, child abuse and unusual incident reporting, immunizations, car seat law, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, baby walkers, exersaucers, bouncy seats and baby jumpers are not allowed in day care. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ALZERKANY, METHAK FAMILY CHILD CARE
FACILITY NUMBER: 376101083
VISIT DATE: 05/31/2022
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Applicant shall comply with all regulations and laws governing family childcare homes and be financially secure to operate a family childcare home for children.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant 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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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 reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted
Entrance Checklist was provided to the applicant.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ALZERKANY, METHAK FAMILY CHILD CARE
FACILITY NUMBER: 376101083
VISIT DATE: 05/31/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, 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 communication.

The following items needs to be corrected prior to granting a license by submitting pictures to LPA within 10 days and a follow up inspection will be needed.
  • The two fire places at the home inaccessible to children
  • Post all the required postings at the home at a prominent area
  • Gate or latch the four sliding doors that leads to the off limit deck area
  • latch the lower drawer cabinets next to the sink that has foils and other sharp objects
  • latch the kitchen drawer that has sharp knives
  • latch up drawer #3 that has sharp objects located to the right side of the kitchen trash can
  • latch the cabinet door that has glass wine bottles or remove the glass wine bottles
  • Add two or more wood at the patio fence deck area to ensure children's safety
  • Block off the side alley of the deck to prevent children access to the off limit deck areas.
  • Move all the alcohol bottles located at the bar cabinet located in the living room
  • Purchase some toys and equipment for day care children.
  • Block off the stairs located in the bonus room to ensure children's safety
  • Purchase a fire extinguisher size 2A10BC or larger

Exit interview conducted and report was reviewed with the applicant Methak Alzerkany.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022
LIC809 (FAS) - (06/04)
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