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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009337
Report Date: 12/10/2019
Date Signed: 12/12/2019 08:59:14 AM

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: 7DATE:
12/10/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Sherine ZakiTIME COMPLETED:
11:09 AM
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Licensing Program Analyst (LPA) Y. Yang made an unannounced Plan of Correction (POC) inspection at the facility. During today's inspection, LPA met with Licensee Sherine Zaki and discussed the purpose of the inspection. On 11/21/19, the Licensee was cited a type A deficiency for allowing infants C1 and C2 to nap on the home's second floor, in rooms that were not approved for use by Licensing and the Fire Marshal. On 11/22/19, the Licensee emailed a written plan of correction to CCLD. The licensee initially informed LPA that she will request a decrease of capacity and request approval to use the home's second floor as a nap room for infants. However, the licensee withdrew her plan and submitted an amended plan to CCLD. Licensee stated that she will use an area designated as the "Classroom/Art Room" on the LIC 999A floor sketch and section off an area in the corner of the room to use as the infant nap area. LPA inspected the infant nap area and approved the area for child care use. Licensee stated she understands that off-limits areas shall remain off-limits to child care children at all times.

LPA observed the Notice of Site Visit and report citing type A deficiency dated 11/21/2019 were posted on the parent board near the facility's front entry. LPA conducted children's records review at 10:09am, and observed that seven children's records contained parental signatures on the LIC 9224 form. LPA cleared the type A deficiency dated 11/21/19 and provided a Letter of Deficiency Citations Cleared to the Licensee.

This report was reviewed and discussed with the Licensee. Notice of Site Visit shall be posted for 30 days from today's inspection. All licensing reports are public information and must be made available upon request for at least three years.

There were no Title 22 deficiencies cited during today's inspection.

Letter of Deficiency clearing a type A citation must be posted for 30 days from today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
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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