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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313415
Report Date: 10/02/2019
Date Signed: 10/02/2019 02:42:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ALASHQAR, NOUFFACILITY NUMBER:
304313415
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
10/02/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Licensee, Alashqar NoufTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA), Nguyen conducted an unannounced case management inspection due to licensee’s request to increase license capacity from small family child care home to large family child care home. Fire clearance from the Orange County Fire Authority was received and approved for a large family child care home. The regulations for Large FCC Home were reviewed. LPA toured the facility with licensee, Alashqar, Nouf. Present during today's inspection were licensee, licensee's spouse, and 4 day care children, 2 of which were under the age of two years. Currently living in the home are two adults and two minor children. The facility was clean, orderly, and was at a comfortable temperature. A review of adults' records on today's date indicates that all adults live in the home or individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

This is a two story home with 3 bedrooms and 2 ½ bathrooms. Licensee stated that OFF LIMITS areas include: the living room, dining room, all upstairs, kitchen and garage. Licensee has designated these areas for care and supervision: family room, the hallway bathroom and the backyard. Licensee acknowledged that children may never enter these off-limit areas. All off limits are barricaded with baby gates. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medication, and hazardous items that could pose a danger to children. The licensee has a current roster of children in care. Children's records were reviewed and in compliance. The facility has conducted an emergency drill within the past six months and log was verified.



The licensee stated that there are no firearms on the premises. LPA advised anytime firearms are present, they must be locked and stored separately from the ammunition. The smoke detector, fire extinguisher, and carbon monoxide detector were present and within regulations. LPA observed CPR & First Aid (exp. 1/20) are current for the licensee. Current immunization information and mandated reporter training were verified by LPA. Continued on Page 2
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALASHQAR, NOUF
FACILITY NUMBER: 304313415
VISIT DATE: 10/02/2019
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The following were discussed: Individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to being present in the facility. Adults must contact a Live-Scan complete LIC 9163. If adult is fingerprinted cleared and associated to another facility, licensee must complete a Criminal Record Clearances or Exemption Transfer Request form (LIC 9182). Contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182 or LIC 9188) with copy of ID and Criminal Record Statement (LIC 508) to fax # (714)703-2831 prior to hiring adult.

LPA advised licensee to contact licensing for any changes to hours and days of planned operation, and for any changes to facility, including on/off limit areas and change in phone number. The licensee has a cell phone that is used for child care. The licensee was reminded that if a cell phone is only used, it must remain on the premises always during hours of operation. Licensee was reminded and understands the home is to be free from smoking always.

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/childganda.htm.



LPA provided the licensee copy of Never Ever Shake a Baby, Safe Sleep and Lead handouts. The applicant was also informed to visit the www.ccld.ca.gov website for Quarterly Updates.

The home was in compliance with Title 22 Regulations. LPA informed licensee that a final review of the file will be done before the large family child care license is issued. The licensee will be notified if any corrections or additions need to be completed. Pending review and approval, a large family child care license will be granted.

Continued on Page 3
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ALASHQAR, NOUF
FACILITY NUMBER: 304313415
VISIT DATE: 10/02/2019
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Inspection report review and exit interview was conducted. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. First level should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3