073408859-9-2-2021-02-CC-THAR-C6GSA3-20210902134141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408859
Report Date: 09/02/2021
Date Signed: 09/02/2021 01:41:55 PM

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: 4	DATE:	09/02/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	ZUHAL AMANYAR		TIME COMPLETED:	02:00 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	Licensing Program Analyst Tasha Alexander met with licensee ZUHAL AMANYAR for an unannounced ANNUAL/REQUIRED inspection. Present for the inspection were licensee and 4 children in care consisting of 3 infants and 1 preschooler. LPA toured the facility and backyard for a health and safety inspection. Children's file were reviewed. Today there is 1 child that does not have immunization records in file. The home is equipped with a fully charged 3A40BC fire extinguisher, working smoke alarm, and working carbon monoxide detector. There is a working telephone in the home, no change. Per licensee there are no fire arms on the premises. Today there is a wading pool located in the backyard that has water. The pool was emptied immediately. There are no hot tubs, or other bodies of water at the home. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR and 1st Aid training which expires 5/2023 respectively. The off limits areas are the entire upstairs, kitchen, garage and the left and right sides of the backyard. There is a child safety gate at the bottom of the stairs. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates. A review of staff records on 8/17/21 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption. Flu vaccination is not up to date. Today the newly implemented mandatory mandated reporter training course has also been discussed. certificate provided- expiration 6/2023 CONTINUED ON 809-C

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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: 09/02/2021

NARRATIVE

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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

This report must be available for public review for 3 years. An exit interview was conducted. A notice of site visit was posted.

PLEASE SEE 809-D FOR CITATION

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: AMANYAR, ZUHAL	FACILITY NUMBER: 073408859
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/30/2021 Section Cited	1 2 3 4 5 6 7	597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions. (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

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