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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100171
Report Date: 01/10/2020
Date Signed: 01/10/2020 12:24:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ALKHALEIF, ASMAA FAMILY CHILD CAREFACILITY NUMBER:
376100171
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
01/10/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Asmaa AlkhaleifTIME COMPLETED:
12:40 PM
NARRATIVE
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An unannounced case management inspection was conducted today by LPA Nancy Diaz and OT Tiffanie Diep. The purpose of this inspection is in reference to Mrs. Alkhaleif's request for an increase of capacity. She was home today with her husband, Azzam Alkhaleif and their 4 minor children (ages 1, 6, 8 and 11). Her 11-year old daughter helped translate this inspection in Arabic.

A tour of the home was conducted to ensure that the environment is safe for children. Children have access to the living room, dining, kitchen, hallway bathroom, bedroom to the left and the back yard. A fire marshall inspection clearance was received on 1/7/2020.

An exit interview was conducted with Mrs. Alkhaleif. She was provided a copy of the facility's appeal rights (LIC 9058 01/16) and her signature on this form acknowledges receipt of these rights.

NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Mrs. Alkhaleif post notice of site visit.

Type B deficiencies were cited today. These deficiencies if not corrected poses a potential risk to the health, safety and personal rights of children in care.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ALKHALEIF, ASMAA FAMILY CHILD CARE
FACILITY NUMBER: 376100171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2020
Section Cited

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Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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This regulation was not met as evidenced by LPA's observation. Several bottles of cleaning agents were observed accessible in the bathroom and kitchen due to broken latches.
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Type B
01/20/2020
Section Cited

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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
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This regulation was not met as evidenced by LPA's review of children's files. Mrs. Alkhaleif is not maintaining current information on form LIC 700
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ALKHALEIF, ASMAA FAMILY CHILD CARE
FACILITY NUMBER: 376100171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2020
Section Cited

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The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
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This regulation was not met as evidenced by LPAs review of childrens' records. Mrs. Alkhaleif failed to maintain immunization for 2 children in her care (ages 1 & 2).
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3