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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408859
Report Date: 06/05/2024
Date Signed: 06/05/2024 01:50:14 PM

Document Has Been Signed on 06/05/2024 01:50 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:AMANYAR, ZUHALFACILITY NUMBER:
073408859
ADMINISTRATOR/
DIRECTOR:		AMANYAR, ZUHALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 305-6909
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
06/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Netsanet WordofaTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 06/05/2024 at 12:30 PM Licensing Program Analysts Sikia Blue arrived to deliver complaint findings to licensee. LPA met with the assistant Netsanet Wordofa in person and Zuhal Amanyar over the phone. Present in the home was licensee assistant Netsanet Wordofa and 9 children. LPA informed licensee and assistant Netsanet Wordofa the purpose of todays visit.

Upon arrival at 12:30 PM LPA observed 9 children present which included 3 infants and 7 preschool children. Family child care home (FCCH) is not in ratio as the assistant was by herself at the time of LPA arrival. LPA explained the importance of following ratio guidelines to ensure the saftey of children in care. see LIC 809Dat 12:40 PM a preschool child was picked up to put FCCH back in ratio.LPA informed licensee of being out of ratio and FCCH will be cited a TYPE B deficiency because LPA observed that there were 9 children in care (3 infants and 7 preschool children). Licensee stated this does not happen normally and had an emergency. This was an isolated incident that was not intentional and posed an potential risk to the health and safety of children in care.

California code of regulations Title 22, Division 12, Chapter 1, Article 6, section 102416.5(b)(2)(e) is being cited on the attached LIC 809-d.

Exit interview conducted at 1:50 PM and appeal Rights were provided.

Licensee was given a notice of site visit to be posted for 30 days, and report was given and reviewed with the licensee Zuhal Amanyar over the phone and assistant Netsanet Wordofa.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Sikia Blue
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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 06/05/2024 01:50 PM - It Cannot Be Edited


Created By: Sikia Blue On 06/05/2024 at 01:34 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: AMANYAR, ZUHAL
FACILITY NUMBER: 073408859

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2024
Section Cited
CCR
102416.6(b)(2)(e)

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102416.5(b)(2)(e)
(e)If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections..
(b)(2) Six children, no more than three of whom may be infants;
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Licensee shall ensure that there are 2 people available anytime the ratio exceeds the required capacity. LIcensee will write a statement explained how FCCH will achieve this and submit to LPA by 06/14/2024.
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The requirement was not met......
because licensee was not at the home and assistant was left alone with 9 children (3 infants and 7 preschool children), which put the facility out of ratio and this posed a potential risk of the health and safety of children 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:Mayla Mendoza
LICENSING EVALUATOR NAME:Sikia Blue
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024


LIC809 (FAS) - (06/04)
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