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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623899
Report Date: 02/18/2022
Date Signed: 02/18/2022 02:39:08 PM


Document Has Been Signed on 02/18/2022 02:39 PM - It Cannot Be Edited

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:AOUF, NESRINFACILITY NUMBER:
343623899
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
02/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Nesrin AoufTIME COMPLETED:
02:50 PM
NARRATIVE
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At 11:50 a.m. on Friday, February 18th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Nesrin Aouf, for the purpose of an unannounced required - 1 year inspection. Licensee has also requested a change of capacity to increase to a large family child care home. A fire clearance STD850 form is on file with the department. Census upon time of arrival consisted of 1 infant, 3 preschool children, and 1 school age child. LPA provided an entrance checklist to Licensee upon arrival. Licensee provided criminal record clearance for all adults in the home. Hours of operation are 24 hours a day, 7 days a week. Licensee was reminded that no children shall be in care for over a 24 hour period. LPA reviewed overnight care regulations with Licensee.

A health and safety inspection was conducted in all areas accessible to children. Off limits areas consist of master bedroom #1, bedroom #3, and garage. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a working phone, 2A10BC fire extinguisher, and a functioning smoke detector. LPA did not observe a carbon monoxide detector. Licensee stated there are no weapons nor poisons in the home. Toxic and hazardous items were appropriately stored, inaccessible to children. Backyard outdoor play space is fenced. Licensee was reminded to remove any broken items.

LPA reviewed children and facility files and observed required documents including consent for emergency medical treatment, emergency information card, and immunization records. LPA provided form CDPH 286 to document immunization records. Current in person EMSA CPR and First Aid certification was verified and expires 1/17/2023. LPA reviewed that any adults assisting with children must have a signed statement acknowledging requirement to report child abuse LIC9108.

Fire Drills have been conducted and documented.

report continued on 809-C.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2022
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: AOUF, NESRIN
FACILITY NUMBER: 343623899
VISIT DATE: 02/18/2022
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One infant child over 12 months was in care during time of inspection. LPA observed an infant play yard used to store infant equipment. Licensee stated that infant child does not use play yard. LPA reviewed infant safe sleep regulations and reminded Licensee that 15 minute checks of sleeping infants must be documented.

This provider is not currently providing IMS services to children in care. Licensee understands that there must be a plan of action on file for any children requiring IMS.

A staff interview was conducted. The department's inspection authority was discussed.

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: https://www.ada.gov/childqanda.htm.

Annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

Effective today, LPA Guerra will recommend increase in capacity from a small family child care home to a large family child care home to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child is in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years. When there is no assistant present, then it will revert back to the small capacity.



This facility evaluation report was reviewed and discussed with the licensee. A Notice of Site Visit was provided and shall remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.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. The licensee's signature on this form acknowledges receipt of this form.

Title 22 deficiencies are cited on the subsequent pages of this report. Appeal rights were provided. Technical assistance was conducted.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/18/2022 02:39 PM - It Cannot Be Edited

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: AOUF, NESRIN
FACILITY NUMBER: 343623899

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4