343622691-1-31-2020-53-CC-ASIA-BLCV2X-20200131150352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622691
Report Date: 01/31/2020
Date Signed: 01/31/2020 03:04:00 PM

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:	ESMAIL, EZDIHAR		FACILITY NUMBER:	343622691
ADMINISTRATOR:	ESMAIL, EZDIHAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 624-0366
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	14	CENSUS: 2	DATE:	01/31/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Ezdihar Esmail		TIME COMPLETED:	03:15 PM

NARRATIVE

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Licensing Program Analyst (LPA) Amy Silva met with Ezdihar Esmail for an unannounced random annual inspection. The census included two children ages 3 and 4 years old. Off-limit areas include: The entire main body of the house. Licensee acknowledges that children may never enter these off-limit areas. At today's visit LPA approved the single car garage to be on-limits. The garage is insulated, has a portable AC/Heater and is appropriately furnished. The single car garage will be used as an additional activity area for the children.

There are no "bodies of water" at this home. Licensee states there are no weapons or firearms in the home. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fire extinguisher, carbon monoxide detector and smoke detector meets regulations. Safe toys and play equipment are observed. There is a working telephone on the premises. Adequate supervision is being provided during this visit.

The capacity as specified on the license is being maintained. Staff-child ratios are maintained. All adults who reside or work in the home have a criminal record clearance or exemption. Pediatric CPR/FA is current and will expire August 2020. Mandated reporter training is current and will expire August 2020. A child roster is maintained. Fire and disaster drills are conducted at least twice a year. Two child records were reviewed. Hours of operation are Monday through Friday 7:00AM to 5PM.

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 809C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ESMAIL, EZDIHAR	FACILITY NUMBER: 343622691
	VISIT DATE: 01/31/2020

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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 provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regard to new regulations.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Licensee and provided copies. An exit interview was conducted. Notice of Site Visit was provided and Licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020

LIC809 (FAS) - (06/04)

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