015700104-5-4-2020-52-CC-LCLN-BPAN5M-20200504100942

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700104
Report Date: 04/30/2020
Date Signed: 05/04/2020 10:09:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	BAWAZIR, AMEERA & GHNIMAT, FERAS		FACILITY NUMBER:	015700104
ADMINISTRATOR:	BAWAZIR, AMEERA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 480-8126
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	14	CENSUS:	DATE:	04/30/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:33 PM
MET WITH:	Ameera Bawazir Feras Ghnimat		TIME COMPLETED:	04:34 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	DUE TO THE COVID-19 SHELTER IN PLACE ORDER BY THE GOVERNOR OF CALIFORNIA, THIS PRE-LICENSING VISIT WAS DONE VIA TELE-VISIT THROUGH ZOOM On April 30, 2020 at approximately 1:30pm, Licensing Program Analyst (LPA) Lisa Clayton met with applicants Ameera Bawazir and Feras Ghnimat (VIA TELE-VISIT ZOOM CALL) for an ANNOUNCED PRE-LICENSING INSPECTION. Present for this visit were both applicants, and their 8yr old son Rayyun. The licensee and LPA toured the home using a tablet and the Zoom app to conduct a Health and Safety Inspection. The facility currently plans to operate 24hrs, Monday through Sunday. This is a one story home which consists of a living room/dining room, 3 bedrooms, a storage room, a hallway bathroom, master bath, kitchen, laundry room, backyard, and detached storage room. The home is neat and clean, with wall heaters. The ISOLATION AREA will be the in childcare bedroom away from children in care. The Off-Limit areas will be inaccessible by child safety gates, closed and/or locked doors and visual supervision. The living room has a fireplace which is blocked to prevent access by children in care. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during today's tele-inspection. On-limit-areas include: Living room/dining room (which was converted into a children’s playroom), kitchen, childcare bedroom, hall bathroom and the backyard. Off-limit-areas include: Master bedroom, master bath, 1 bedroom, the storage room, laundry room, and the side yard in the front of the house. There are ample age appropriate toys, learning materials, and equipment that appear to be safe and in good condition. The home has a fully charge 2A10BC fire extinguisher, working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2020

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BAWAZIR, AMEERA & GHNIMAT, FERAS	FACILITY NUMBER: 015700104
	VISIT DATE: 04/30/2020

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LPA Clayton provided a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes. The applicant was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

This home is recommended for provisional Licensure on 04/30/2020. This report shall remain on file for 3 years. Exit interview conducted with the applicant.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2020

LIC809 (FAS) - (06/04)

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