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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620546
Report Date: 07/13/2023
Date Signed: 07/13/2023 01:50:02 PM


Document Has Been Signed on 07/13/2023 01:50 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:YOUNATHAN, MARIAMFACILITY NUMBER:
393620546
ADMINISTRATOR:MARIAM YOUNATHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 506-1924
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY:14CENSUS: 6DATE:
07/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mariam YounathanTIME COMPLETED:
02:00 PM
NARRATIVE
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On 07/13/2023 at 10:00 AM, Licensing Program Analyst (LPA) Tiffanie Diep met with Licensee Mariam Younathan for the purpose of an unannounced annual inspection, and Licensee guided LPA on a tour of the home. LPA observed six children present in the home with Licensee and their adult child/assistant. Licensee's operating hours are Monday through Friday from 7:00 AM to 6:00 PM. Licensee was reminded that annual fees are due on 08/04/2023 and LPA discussed accepted payment methods.

All individuals subject to a criminal record review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

A health and safety inspection of the home’s interior and exterior was conducted in all areas accessible to children. The off-limits areas in the home include all bedrooms, master bathroom, and garage. LPA observed the required postings and a working phone. LPA observed a 2A10BC fire extinguisher meets regulations and verified both smoke and carbon monoxide detectors were functional. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed a bathroom and verified that toxic and hazardous items were inaccessible to children in care. LPA observed cleaners stored in laundry room out of reach and inaccessible to children in care. LPA observed the living room area with age-appropriate toys for children. Licensee stated there are no weapons in the home. LPA observed a fireplace that was barricaded by a baby gate. The outdoor play area was inspected and is surrounded by a wooden fence. LPA walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. LPA did not observe bodies of water on the premises.
Continues on 809-C
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie DiepTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YOUNATHAN, MARIAM
FACILITY NUMBER: 393620546
VISIT DATE: 07/13/2023
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Continued from 809 (Page 2)

LPA reviewed five children's files, and LPA observed emergency information and required immunization records were on file. LPA observed a current roster. LPA discussed the requirement to conduct and document fire and disaster drills at least once every six months. LPA verified Licensee's immunization records were available in the facility file. Current EMSA pediatric CPR and first aid certification was verified and expires on 12/06/2023. Mandated Reporter Training certificate expired on 07/03/2023. LPA discussed the mandated reporter training requirement and Licensee was reminded to renew the course every two years. Because Licensee rents/leases the home, proof of landlord notification is required. LPA observed the Property Owner/Landlord Notification form (LIC 9151) that Licensee confirms was provided to the property owner/landlord. Licensee obtained a signed Property Owner/Landlord Consent Form (LIC 9149).

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. LPA observed 15-minute napping logs for infants under 24 months and a copy of the Individual Sleeping Plan (LIC 9227) for infants under 12 months during the inspection.



Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at https://www.ada.gov/resources/child-care-centers/.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie DiepTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YOUNATHAN, MARIAM
FACILITY NUMBER: 393620546
VISIT DATE: 07/13/2023
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Continued from 809-C (Page 3)

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on interviews conducted and record review, a deficiency is being cited on the attached LIC 809-D. LPA Tiffanie Diep informed the licensee, Mariam Younathan, that this report dated 07/13/2023 documents one Type B citation. Type B citations are a potential risk to the health, safety, or personal rights of children in care.

An exit interview was conducted and report was reviewed with the licensee, Mariam Younathan. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie DiepTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/13/2023 01:50 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: YOUNATHAN, MARIAM
FACILITY NUMBER: 393620546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews conducted and record review, the licensee did not comply with the section cited above as LPA observed the last fire and disaster drill was conducted on 04/05/2022 which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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 Licensee stated they will provide documentation of completed drill to LPA by 08/14/2023
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: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Tiffanie DiepTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4