344500443-7-21-2021-53-CC-ASIA-C55NXW-20210721105150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500443
Report Date: 07/21/2021
Date Signed: 07/21/2021 10:52:02 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:	MAHFOUZ, LAILA		FACILITY NUMBER:	344500443
ADMINISTRATOR:	MAHFOUZ, LAILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 670-3716
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	14	CENSUS: 0	DATE:	07/21/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Laila Mahfouz		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Amy Silva met with the Licensee Laila Mahfouz for the purpose of a pre-licensing inspection for a change of location for a large family daycare home. Licensee was previously licensed under facility #343619284. The large family childcare home was inspected and cleared by the Elk Grove Fire Department on 7/12/21. Licensee and spouse living in the home have a criminal record clearance. A health and safety inspection was conducted inside and out. The two story home has an unfenced front yard, 4 bedrooms, 3 bathrooms, a living room, family room, dining room, daycare room, kitchen, laundry room, fenced backyard and a garage. The off-limits areas in the home include; Entire Upstairs, garage and laundry room. The are two fire places in the home. The fire place in the living room and the fire place in the family room are appropriately screened to prevent access to children. Toxic and hazardous items are inaccessible to children. LPA observed a functioning smoke detector and carbon monoxide detector in the home that was tested at 10:00 am and are in operable condition. LPA observed a fire pull station located on the left side of the front door of the home. LPA observed a 3A10BC fire extinguisher, located in the kitchen by the sink. Current pediatric CPR/First Aid training, lead training, and Mandated Reporter Training was completed and verified. Licensee stated there are no weapons in the home. There is no pool at the home. No other bodies of water were observed at the home. *Report continued on 809-C*

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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: MAHFOUZ, LAILA	FACILITY NUMBER: 344500443
	VISIT DATE: 07/21/2021

NARRATIVE

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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

This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. Licensee was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

LPA reviewed with Licensee the handouts “A Child Care Provider’s Guide to Safe Sleep," Safe Sleep Regulations, Safe Sleep Log, and “Safe Sleep Regulation Concepts” and "Lead Poisoning Facts" and gave her a copy of these handouts.

An exit interview was conducted. Appeal rights provided.

Effective today's date, 07/21/2021, facility is approved to serve up to either 14 children, two of which must be at least 6 years of age and no more than three may be infants; or 12 children, four of which may be infants. Infants are children under the age of 2. LPA reminded Licensee if no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Home.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

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