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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101215
Report Date: 01/11/2023
Date Signed: 01/11/2023 08:59:26 AM

Document Has Been Signed on 01/11/2023 08:59 AM - 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:
01/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Ghiahib Al DujailiTIME COMPLETED:
09:15 AM
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On 1/11/23 at 8:00 AM, Licensing Program Analyst(LPA) Adrian Mangina conducted an unannounced case management for non-compliance with Licensee Ghiahib Al Dujaili. Also ,in the home was husband Haitham Al Sakarchi. There were no minor child and no daycare children present. Proper ratios and supervision was observed. Licensee's 3 bedroom, 3 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Last disaster drill was conducted 9/9/22, last earthquake drill was 9/23/22. The 2A10BC fire extinguisher, smoke alarm, and carbon monoxide detector 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. Licensee understands visual supervision is to be maintained at all times during outdoor activities Licensee states that there are no weapons in the home. 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. Required documents have been posted.

First Aid and CPR expire 8/2023. Licensee was exempted from Mandated Reporter training due to language. Licensee owns home and has provided a copy of the mortgage statement. Staff immunization requirements per SB792 were met.

Licensee states she is utilizing the following areas for child-care: dining area, kitchen, bathroom 1, childcare room 1 and childcare room 2 as well as front yard. The following areas will be off limits: bedroom 1, bedroom 2, bathroom 2, master bathroom, Second living room, attached garage, and back yard. Off-limit areas are made inaccessible through use of door knob covers, gates, and safety latches. The fireplace located in second living room. was screened. There are no bodies of water observed during time of visit. Licensee states there are no firearms or weapons in the home. The Applicant has safe, age appropriate toys and equipment available for children.
(continued on LIC809-C...)
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2023
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 DUJAILI, GHIAHIB FAMILY CHILD CARE
FACILITY NUMBER: 376101215
VISIT DATE: 01/11/2023
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LIC809 page 2

LPA Mangina reviewed capacity limitations, supervision, physical plant, reporting requirements, bodies of water, storage of hazardous items, Shaken Baby Syndrome, SIDS, emergency drills and childcare roster. LPA reminded Licensee that walkers, jumpers, exersaucers and bouncers are not permitted for use in the day care. LPA reviewed safe sleep guidelines.

Licensee was advised to regularly visit the Community Care Licensing WEB SITE: https://www.cdss.ca.gov/inforesources/child-care-licensing for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248. LPA 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:
https://www.ada.gov/childqanda.htm

Licensee was 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.

No deficiencies cited today

Exit interview conducted and report was reviewed with the licensee, Ghiahib Al Dujaili. The Licensee was provided a copy of this report. A Notice of Site Visit (LIC9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023
LIC809 (FAS) - (06/04)
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