393622599-6-9-2023-53-CC-ESIA-CSMPUC-20230609113718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393622599
Report Date: 06/09/2023
Date Signed: 06/09/2023 11:37:22 AM

Document Has Been Signed on 06/09/2023 11:37 AM - 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:	ASFOUR, SEHAM		FACILITY NUMBER:	393622599
ADMINISTRATOR:	ASFOUR, SEHAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 513-4631
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	14	CENSUS: 0	DATE:	06/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Seham Asfour		TIME COMPLETED:	11:45 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	On 06/09/23, Licensing Program Analyst (LPA) Elvira Sierra met with the Licensee,Seham Asfour for the purpose of an unannounced annual inspection. Facility hours of operation are seven days a week 24 hours a day. Licensee was advised never to exceed 24 hours of consecutive care. Licensee stated that no new residents moved into the home since licensure. Present in the facility was licensee and her minor son. No day-care children were present. A health and safety inspection was conducted in all areas accessible to children. Off-limit areas include: Entire upstairs, garage, and backyard. Licensee was reminded that day care children may never enter these off-limit areas. Home is clean and appropriately ventilated. Age-appropriate toys and reading material were observed. There were no hazardous materials or chemicals observed accessible to children. Medications and knives are inaccessible to children. Home has a fireplace in the living room which is barricaded. Licensee stated there are no weapons in the home.Facility has an underground pool with a iron fenced surrounding the pool that meets the fencing requirements. Facility maintains a working phone, a functioning carbon/monoxide detector and a 2A10BC fire extinguisher that meets Fire Marshall standards. LPA reminded Licensee that any changes to the home or any new construction must be reported to Licensing. Current EMSA CPR and First Aid certification was verified (exp 10/24) and proof of Mandated Reporter training certificate was observed (exp 10/24). Facility transport children and provide meals. 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. Report continues on subsequent page 809C--

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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: ASFOUR, SEHAM	FACILITY NUMBER: 393622599
	VISIT DATE: 06/09/2023

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.

LPA discussed the safe sleep regulations 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.

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.

LPA verified the 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.Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information.

Exit interview conducted. This facility evaluation report was reviewed and discussed with the licensee, Seham Asfour. A Notice of Site Visit was posted and should remain posted for 30 days for parental review.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

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