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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620113
Report Date: 08/07/2019
Date Signed: 08/07/2019 11:26:10 AM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ABDUL-WAHAB, SAHARFACILITY NUMBER:
343620113
ADMINISTRATOR:ABDUL-WAHAB, SAHARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 606-0544
CITY:SACRAMENTOSTATE: CAZIP CODE:
95841
CAPACITY:14CENSUS: 9DATE:
08/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Sahar Abdul-WahabTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Seychelle De Luca met with Licensee Sahar Abdul-Wahab for the purpose of an unannounced annual random inspection. Licensee's husband and assistant were also present during the inspection. Licensee's assistant, Serenity Devich, does not have a criminal record clearance. Prior to today's inspection, Licensee notified LPA that she has converted the garage into a play room and a fire clearance request was sent out to have the room inspected.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the four bedrooms, the master bathroom, the bathroom down the hallway to the left, and the garage. LPA inspected the converted garage during today's inspection. LPA observed the required postings, a working phone, 3A40BC fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. Toxic and hazardous items are inaccessible to children. The fireplace is appropriately barricaded to prevent access by children and outdoor play space is fenced.

Four children’s files were reviewed. LPA observed immunization records and signed Family Child Care Home Notification of Parents' Rights in children's files. A current roster is being maintained and fire and disaster drills are documented. Licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires 05/2021.

This provider is currently not providing IMS services to children in care. 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.
Report continues on 809-C.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ABDUL-WAHAB, SAHAR
FACILITY NUMBER: 343620113
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2019
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by
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LPA provided LIC 9163 and advised Licensee on how to fill it out correctly. Licensee will have Ms. Devich go to a Live Scan location and get printed again. Licensee acknowledges that she must call the main office and ask if Ms. Devich and any future residents/assistants are cleared and associated to her license. Licensee will send
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LPA learning Serenity Devich has not obtained a criminal record clearance. LPA learned Ms. Devich went to a Live Scan location, but the form was not filled out correctly. This poses an immediate health and safety concern to children in care. CIVIL PENALTY IN THE AMOUNT OF $100 IS ASSESSED.
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a picture of the completed Live Scan form with receipt to LPA by POC date: 8/8/2019.
Type A
08/08/2019
Section Cited
HSC
1596.795(a)
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Smoking - The smoking of tobacco in a private residence that is licensed as a family day care home shall be prohibited in the home and in those areas of the family day care home where children are present. Nothing in this section shall prohibit a city or county from enacting or enforcing an ordinance relating to smoking in a family day
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Licensee removed the hookah and stated she will submit a written statement acknowledging smoking is not permitted inside the home or in any areas accessible to children. Licensee will also write that she understands an area of the yard must be designated as off-limits, if anyone smokes in the future. Licensee stated her husband only smokes cigarettes off of the
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care home if the ordinance is more stringent than this section. This requirement is not met as evidenced by LPA observing a hookah in the dining room. Licensee stated this belongs to her daughter and it is smoked in the front yard. Licensee stated her husband smokes cigarettes. This poses an immediate health and safety concern to children in care.
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property.

Licensee will submit the written statement to LPA by POC date: 8/8/2019.
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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ABDUL-WAHAB, SAHAR
FACILITY NUMBER: 343620113
VISIT DATE: 08/07/2019
NARRATIVE
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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 verified the annual fees are current. LPA provided and discussed the Safe Sleep in Child Care brochure, Effects of Lead Exposure brochure, and the new blue immunization card.

This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form.



LPA will approve the use of the converted garage, pending approval and clearance by the fire department. Licensee understands she may not use the converted garage until LPA gives approval.

Title 22 deficiencies are cited on the subsequent pages of this report.
Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ABDUL-WAHAB, SAHAR
FACILITY NUMBER: 343620113
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2019
Section Cited
CCR
102416.1(a)
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Personnel Records - Personnel records shall be maintained on each employee... This requirement is not met as evidenced by LPA observing Licensee's assistant does not have required paperwork (with the exception of TB test). This poses a potential health and safety concern to children in care.
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LPA provided a checklist of items required for Licensee's assistant. Licensee will send LPA proof of the missing items by POC date: 9/4/2019.
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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4