073408859-8-20-2019-02-CC-MGUT-BF8MKS-20190820094114

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408859
Report Date: 08/08/2019
Date Signed: 08/20/2019 09:41:20 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	AMANYAR, ZUHAL		FACILITY NUMBER:	073408859
ADMINISTRATOR:	AMANYAR, ZUHAL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 305-6909
CITY:	ANTIOCH	STATE: CA	ZIP CODE:	94531
CAPACITY:	14	CENSUS: 0	DATE:	08/08/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Zuhal Amanyar		TIME COMPLETED:	03:00 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	On 08/08/19, Licensing Program Analyst M. Guirit , met with applicant Zuhal Amanyar for an ANNOUNCED PRE LICENSING INSPECTION. Present for this inspection was applicant, fingerprint cleared husband, Asadullah Amanyar, fingerprint cleared sister-in-law, Shabana Entezar, and sister-in-law's child age two and a half. Fingerprint cleared brother, Mirwais Entezar also resides in the home, but was not present during today's inspection. The home was toured to conduct a Health and Safety Inspection. The facility's operating hours are 6:00 AM - 7:00 PM. The home is two story . The home consists of kitchen, living room (child care room), family room (infant play area), napping area, 3 bathrooms, 3 bedrooms, backyard, laundry room, and attached garage. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are the kitchen, the entire upstairs area, garage, and side yards which will be inaccessible by closed and/or locked doors, child barricade, and visual supervision. The ON LIMIT AREAS are the living room (child care room), family room (infant play area), napping area to right of the doorway entrance, downstairs bathroom, and main backyard. The ISOLATION AREA will be the living room (child care room). Outdoor play area will be the fenced backyard which consists of a small play structure which is secured. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of toys and activities available for children, and they are in good condition and age appropriate. There are no pools, hot tubs or any other bodies of water on the premises. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. The home has a fully charged 2A10BC fire extinguisher, fire alarm approved by the Fire Dept., working smoke detector, working carbon monoxide detector, working telephone, and fully stock First Aid Kit. The fire clearance was reviewed and was granted on 07/01/19. The applicant’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 03/2020. Applicant has completed the Mandated Reporter Training which expires on 07/2021. See 809-C for continuance.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: AMANYAR, ZUHAL	FACILITY NUMBER: 073408859
	VISIT DATE: 08/08/2019

NARRATIVE

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The applicant is in compliance with new immunization law which pertains to day care providers. The fireplaces located in the living room (child care room) and family room (infant play are) are screened to prevent access by children. Per applicant, there are no firearms in the home. A copy of the mortgage statement was reviewed and copy obtained and shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed.

Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov .http://www.myccl.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 inspected the home and finds it to be in substantial compliance with title 22. Due to printer issues the computerized report will be mailed and a copy of a written 809 will be provided to the applicant. This home is recommended for licensing, however, will remain pending for manager approval. This report shall remain on file for 3 years. Exit interview conducted with applicant.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 622-2624
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

LIC809 (FAS) - (06/04)

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