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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423455
Report Date: 07/13/2022
Date Signed: 07/13/2022 02:58:13 PM

Document Has Been Signed on 07/13/2022 02:58 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:TOUATI, KAMELFACILITY NUMBER:
013423455
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kamel TouatiTIME COMPLETED:
03:15 PM
NARRATIVE
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On 07/13/22, Licensing Program Analysts (LPAs), Melissa Guirit and Melissa Domantay conducted an unannounced case management inspection during a complaint investigation. LPAs met with licensee, Kamel Touati. Present during today's inspection were 3 infants, licensee, and assistant. Assistant is not fingerprint cleared and was left alone with the children until licensee arrived at the home. Licensee was not present between 1:25 PM to 1:37 PM. Once licensee arrived, a tour of the facility was conducted to ensure the health and safety of children in care. LPAs searched for assistant's fingerprint clearance, but no result was found. Children and staff roster were obtained from licensee.

See 809-D for Type A deficiency resulting in a civil penalty.

Exit interview conducted and appeal rights provided to licensee, Kamel Touati.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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Document Has Been Signed on 07/13/2022 02:58 PM - It Cannot Be Edited


Created By: Melissa Guirit On 07/13/2022 at 02:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: TOUATI, KAMEL
FACILITY NUMBER: 013423455

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2022
Section Cited
CCR
102370(d)(1)

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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or
This is not evidenced by:
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Licensee must provide criminal background clearance before staff, Hina Akbar returns to facility.
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Based on record review, the licensee did not comply with the section cited above in due having an adult working in the home without a criminal background clearance, which poses an immediate health, safety or personal rights risk to persons in care.
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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:Loretta Dyson
LICENSING EVALUATOR NAME:Melissa Guirit
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022


LIC809 (FAS) - (06/04)
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