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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009337
Report Date: 11/21/2019
Date Signed: 11/22/2019 02:55:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ZAKI, SHERINE FCCHFACILITY NUMBER:
493009337
ADMINISTRATOR:ZAKI, SHERINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 280-3144
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:14CENSUS: 10DATE:
11/21/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Sherine ZakiTIME COMPLETED:
02:30 PM
NARRATIVE
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During an inspection visit to the facility on 11/21/19, Licensing Program Analyst (LPA) Y. Yang observed at 12:45pm that several of the home's upstairs bedrooms were being used as nap rooms by infants (C1 and C2). The doors to the bedrooms used by C1 and C2 were shut. There was a barricade near the base of the stairs, making the stairs inaccessible to day care children. LPA did not observe a barricade at the top of the stairs. LPA observed a crib in the master bedroom, office, and spare bedroom.

The upstairs bedrooms were not approved for child care use by Community Care Licensing Division (CCLD) or by the Fire Marshal. Approval by the Fire Marshal is a condition of licensure for a large FCCH. The home's entire second floor is currently designated as "off-limits." The licensee stated that she will not use the home's second floor for child care until her decrease of capacity request application has been approved and the upstairs bedrooms have been inspected and approved by CCLD.

During today's inspections visit, there were nine children and two staff members present at the home.This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: ZAKI, SHERINE FCCH
FACILITY NUMBER: 493009337
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/22/2019
Section Cited

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Alteration to Existing Building or Grounds. Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
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This requirement was not met at evidenced: based on LPA's observations on 11/21/19 at 12:45pm and the licensee's (S1) own admission at 01:33pm and interviews with staff S2-S4, child C1 and C2 were allowed to nap upstairs in bedrooms that were not inspected and approved by the Department or by the local Fire Marshal.

This poses an immediate health and safety risk to the children in care.
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Licensee stated that the home's second floor will not be used for child care until it has been inspected and approved by CCLD.

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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2019
LIC809 (FAS) - (06/04)
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