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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101215
Report Date: 08/10/2022
Date Signed: 08/12/2022 02:25:37 PM

Document Has Been Signed on 08/12/2022 02:25 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 DUJAILI, GHIAHIB FAMILY CHILD CAREFACILITY NUMBER:
376101215
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/10/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Ghiahib Al DujailiTIME COMPLETED:
04:45 PM
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On 8/10/22 at 2:30 PM Licensing Program Analyst (LPA), Adrian Mangina, conducted an announced Pre-Licensing Change of Location Inspection with the Licensee, Ghiahib Al Dujaili. Also, in the home was Licensee’s husband Haitham Al Sarkarchi. Licensee owns the home and has provided proof of control of property. The 3 bedroom, 3 bath, single story home was toured and inspected to ensure an environment safe for the care and supervision of children. The 2A10BC fire extinguisher, smoke alarm, and carbon monoxide detector all located in the kitchen meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee will utilize fully fenced front yard for outdoor activities. Applicant understands visual supervision is to be maintained at all times during outdoor activities. Applicant states that there are no weapons in the home and has certified on the application 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. Licensee owns home and has provided a copy of the mortgage statement.

First Aid and CPR expire 8/2023 and assistant’s First Aid and CPR expires 7/2024. Licensee’s preventative health practices course was completed on 8/10/22 Applicant and assistant are exempt from Mandated Reporter Training AB 1207, as primary language is Arabic. Staff immunization requirements per SB792 were met. Staff immunization and TB requirements were met. Required documents have been posted. Updated preventative Health training was completed by Licensee on 8/10/22. Licensee provided proof of completion and will forward the certificate when it arrives in the mail in 7 to 10 days.

Licensee will be using the following rooms for childcare: dining area, kitchen, bathroom 1, childcare room 1

(continued on LIC809 page 2)
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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 DUJAILI, GHIAHIB FAMILY CHILD CARE
FACILITY NUMBER: 376101215
VISIT DATE: 08/10/2022
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(LIC809 page 2)

and childcare room 2 as well as front yard. The following areas will be off limits: bedroom 1, bedroom 2, bathroom 2, master bathroom, Secodn living room, and back yard. Off-limit areas are made inaccessible through use of door knob covers, gates, and safety latches. The fireplace in the living room is screened to prevent access. The attached garage will also be off limits and is kept inaccessible through the use of a door knob cover to make it inaccessible to children. The Applicant has safe, age appropriate toys and equipment available for children.

The new provider packet was provided to licensee including information on child abuse reporting, children’s records, immunizations, adults living or working in the home, Effects of Lead, shaken baby syndrome, Safe Sleep regulations, SIDS, Incidental Medical Services, and the YMCA Resource Center, and New COVID Guidance for Child Care. Licensee 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 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.

LPA discussed the safe sleep regulations with licensee 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 of the importance of checking for

(continued pn LIC809 page3)
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 DUJAILI, GHIAHIB FAMILY CHILD CARE
FACILITY NUMBER: 376101215
VISIT DATE: 08/10/2022
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(LIC809 page 3)

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.

Licensee reminded that all adults 18 and over living or working in the home, 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.

Licensee 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.

Applicant owns home and may care for up to 8 children, including any children living in the home ten years old and under. No corrections are needed. A small license up to 8 children may be granted upon final file review.

An exit interview was conducted with the Licensee Ghiahib Al Dujaili. The Licensee was provided a copy of this report .
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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