013421864-3-23-2023-02-CC-ILOA-CQ7UXR-20230323155846

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421864
Report Date: 03/23/2023
Date Signed: 03/23/2023 03:58:52 PM

Document Has Been Signed on 03/23/2023 03:58 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ELSAYED, MANAR		FACILITY NUMBER:	013421864
ADMINISTRATOR:	ELSAYED, MANAR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 649-9269
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94703
CAPACITY:	14	CENSUS: 3	DATE:	03/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Manar Elsayed		TIME COMPLETED:	04:06 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 March 23, 2023 at 1:45pm Licensing program Analyst (LPA) Indira Loza arrived at the facility to conduct an annual random inspection. Present for the inspection were the Licensee, two infants, and one preschool age child. The home was inspected to conduct a Health and Safety check. Operating hours are Monday through Thursday 8:00am to 5:00pm. The home consists of a living room, dining room, kitchen, and bathroom on the first floor, and three bedrooms and a bathroom on the second floor. The on limit areas include the living room, dining room, and the bathroom. The off limit areas include the entire second floor, which is made inaccessible by gate, closed and/or locked doors and visual supervision. The isolation area is on the couch until the parents arrive. The Licensee’s Pediatric CPR and First Aid training has been completed and expires on October 2023. LPA obtained the children’s files for review and the children's roster. The Licensee provides breakfast, lunch, and one snack. The home was observed to be neat and clean with ample age appropriate toys. LPA observed the home to have heat and ventilation for the comfort of children. Per Licensee there are no firearms in the home. The Licensee has Liability Insurance which expires on November 30, 2023. There was a 2A10BC fire extinguisher in the home. LPA observed a working carbon monoxide and smoke detector. Licensee was reminded that California Law requires Licensee to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. The Licensee is reminded that any structural changes to the home or additions to the childcare *****************Report continues on LIC 809-D*************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ELSAYED, MANAR	FACILITY NUMBER: 013421864
	VISIT DATE: 03/23/2023

NARRATIVE

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facility must be reported to Community Care Licensing.

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)/ (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.

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 athttps://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
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.

No citations were issued during today's visit.
Exit Interview conducted with Licensee Maynard Elsayed. Report and Appeal rights provided.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023

LIC809 (FAS) - (06/04)

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