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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622756
Report Date: 01/09/2020
Date Signed: 01/09/2020 11:57:38 AM

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:ALBAN, DAYYANFACILITY NUMBER:
343622756
ADMINISTRATOR:ALBAN, DAYYANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 647-3380
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:14CENSUS: 10DATE:
01/09/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Dayyan Alban TIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Amy Silva met with Dayyan Alban for an unannounced random annual inspection. The census included 10 children ages 1, 2, 2, 2, 2, 2, 2, 4, 4, and 4 years old. Off-limit areas include the entire upstairs, garage and laundry room. Licensee acknowledges that children may never enter these off-limit areas. Upon arrival, children were engaging in indoor activities.

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. There are no excluded individuals present at this home. Pediatric CPR/FA is current and will expire 9/11/2020. Mandated reporter training is current and will expire 6/22/20. A child roster is maintained. Fire and disaster drills are conducted at least twice a year. Last disaster drill was conducted on 10/1/2019 and documented. Four child records and 2 staff files were reviewed. Hours of operation are Monday through Friday 6AM to 6 PM.

Report continues on 809C

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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: ALBAN, DAYYAN
FACILITY NUMBER: 343622756
VISIT DATE: 01/09/2020
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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..

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.

LPA provided and discussed Effects of Lead Exposure brochure and the revised CDPH 286 form for the documentation of immunization's.

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 MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
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