376623903-6-8-2022-51-CC-SSIO-CF7QL5-20220608121523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376623903
Report Date: 06/08/2022
Date Signed: 06/08/2022 12:15:50 PM

Document Has Been Signed on 06/08/2022 12:15 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	KHOURY, ARLETTE FAMILY CHILD CARE		FACILITY NUMBER:	376623903
ADMINISTRATOR:	ARLETTE KHOURY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 775-8725
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92128
CAPACITY:	14	CENSUS: 8	DATE:	06/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Arlette Khoury		TIME COMPLETED:	12:25 PM

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	On 06/08/2022 at 9:50 AM, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced random inspection and to add an additional side yard area that has turf and a new kid size trampoline for the day care children to use. Licensee was provided the Inspection Checklist (LIC 126) upon entry to the facility. The home was toured and inspected to ensure an environment safe for the care and supervision of children. Present at the facility were the Licensee, her helpers Shokria Nawaey and Sofia Gull supervising 8 day care children including 3 day are infants. The home has a fully charged fire extinguisher size 2A10BC and smoke detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee stated that there are no bodies of water or weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances. Licensee’s First Aid and CPR certifications are valid through 02/06/2024 and her helper Shokria Nawaey's First Aid and CPR are valid through 10/2023. Licensee completed the online mandated child abuse training on 05/15/2022 and helper Sofia Gull completed the online mandated child abuse training on 05/30/2022 an it must be renew every two years. 8 of the children’s records were reviewed and are in ordered. Facility has an updated roster and fire drill log available for review. Licensee last conducted a drill with the children in care on 04/18/2022. A copy of the facility roster was obtained during today’s inspection. Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include bedroom #2, den area, dining room, kitchen, covered patio area and hallway bathroom. Off limits areas include: master bedroom/bath, bedroom #1 and garage. Areas are inaccessible by having the doors closed. The facility has sufficient toys and equipment available. The home has a fenced backyard available for

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KHOURY, ARLETTE FAMILY CHILD CARE	FACILITY NUMBER: 376623903
	VISIT DATE: 06/08/2022

NARRATIVE

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outdoor activities. Licensee has requested to add a side yard area that has turf and a trampoline is recently purchased for the children to use. Licensee was advised to follow the manufacture recommendation by having no more than one child inside the trampoline at a time. The trampoline is designed for children 3-10, also the person should weigh less than 100 pounds. Visual supervision is required when a child is inside the trampoline.

Per new Senate Bill 792 pertaining to immunizations, which require all adults in daycare operation to have proof of immunizations for; Measles, Pertussis and Influenza.

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

The following items were discussed with provider: Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. Licensee was provided with information about Heat Related Illness, Sudden Infant Death Syndrome (SIDS), Never Shake a Baby, Safe Sleep for Infants, Best Practice On Supervision, latest car seat poster and Effects of Lead Exposure and reporting responsibilities were discussed. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe. LPA discussed California Megan's Law with provider and advised her to go on the website at www.meganslaw.ca.gov.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KHOURY, ARLETTE FAMILY CHILD CARE	FACILITY NUMBER: 376623903
	VISIT DATE: 06/08/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

See LIC809D for deficiencies and see Technical violations attached.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee .

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/08/2022 12:15 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KHOURY, ARLETTE FAMILY CHILD CARE	FACILITY NUMBER: 376623903
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2022

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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/10/2022
	Plan of Correction
1 2 3 4	Licensee stated that she will purchase a carbon monoxide detector for the home and she will submit a video showing that the home has an operating carbon monoxide to Analyst no later than 06/10/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina Siao	TELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022

LIC809 (FAS) - (06/04)

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