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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021081
Report Date: 09/09/2022
Date Signed: 09/09/2022 01:13:30 PM

Document Has Been Signed on 09/09/2022 01:13 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:FAWAZ FAMILY CHILD CAREFACILITY NUMBER:
198021081
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/09/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Helen FawazTIME COMPLETED:
01:45 PM
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An announced Pre-Licensing Inspection was conducted by Licensing Program Analyst (LPA) Lilli Babcock. A Covid risk assessment was conducted upon entry and appropriate Personal Protective Equipment was used. The purpose of today's visit is to inspect and evaluate facility for initial licensure. Applicant is applying for a Small Family Child Care Home. Present during this inspection was Applicant and child of applicant.

Per applicant, family members residing in the home are 3 adults and 4 children. Per applicant, operation hours will be Monday to Friday, 8:00 AM to 6:00 PM. Applicant states that she will care for children 2 years - 10 years of age.

During this inspection the following was observed:

All areas identified on the facility sketch were inspected, including but not limited to, all off limit areas. This is a two-story home that consists of 6 bedrooms, 3 bathrooms, kitchen, living room, dining room, daycare room, laundry room, front yard, backyard with in-ground swimming pool, and detached garage.

Per applicant, the children will use 1 bathroom, living room, dining room, kitchen, daycare room, and fenced front yard. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service via a cell phone, ventilation and heating. Per applicant, areas off-limits to children and parents are: 6 bedrooms, 2 bathrooms, laundry room, backyard and swimming pool, and garage. All areas inaccessible for children were observed to have a lock and or a security gate making them
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FAWAZ FAMILY CHILD CARE
FACILITY NUMBER: 198021081
VISIT DATE: 09/09/2022
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inaccessible for children in care. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant states that poisons are locked with a key lock in the off-limits garage.


LPA Babcock observed a fire extinguisher in the kitchen. Applicant stated she does not have the receipt of purchase. LPA Babcock observed an electric fireplace in the living room which was observed to be screened and inaccessible for children in care. Smoke and carbon monoxide detectors were tested during the inspection and observed to be operable.

There are toys available for children. Applicant does not have cots or mats for napping children at this time. Applicant states she will not care for infants, however LPA discussed Safe Sleep regulations and how to submit an updated LIC 279 with applicant in the event she chooses to care for infants at a later time.

The applicant states that they will provide snacks for children in care and lunch will be provided by the parents. LPA discussed labeling food brought from home with children’s names.

The applicant has completed the required Preventative Health and Safety Training including Nutrition and Lead Training and Pediatric First Aid and CPR. There are first aid supplies available.

Per applicant, there are no weapons or firearms in the facility. Applicant has one pet, a cat.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FAWAZ FAMILY CHILD CARE
FACILITY NUMBER: 198021081
VISIT DATE: 09/09/2022
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The children will use the front yard for outdoor play, which was observed to be fenced. The front yard mailbox is not firmly seated in the ground making it a hazard to children. Applicant will have the mailbox cemented in the ground, or somehow make it unmovable.

LPA observed an in-ground swimming pool in the backyard. The pool has a 5-foot fence surrounding it, however the pool gate does not self-close and does not have a self-latching device. Applicant will have a new gate delivered to meet licensing requirements. LPA observed french doors on the daycare room, and a window in the living room/dining room and one bedroom that lead to the backyard, but do not provide direct access to the pool. LPA will discuss with Licensing Program Manager (LPM) whether alarms will be required on the door and/or windows. Applicant agrees that fencing will remain in place whenever licensed care is provided, and so long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff.

Applicant states that they will not care for infants. LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Applicant of the importance of checking for recalled infant devices 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FAWAZ FAMILY CHILD CARE
FACILITY NUMBER: 198021081
VISIT DATE: 09/09/2022
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Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm


At 11:00 am The following was discussed with the applicant:

· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.
· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FAWAZ FAMILY CHILD CARE
FACILITY NUMBER: 198021081
VISIT DATE: 09/09/2022
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· No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

· Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com


At 11:10 am, LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. All required forms listed were explained and were provided to the applicant during the visit.
LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FAWAZ FAMILY CHILD CARE
FACILITY NUMBER: 198021081
VISIT DATE: 09/09/2022
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OTHER INFORMATION AND FORMS PROVIDED:
· Handouts provided for Safe Sleeping practices
· Capacity Handout for a Small Family Child Care Home was provided.
· Lead Exposure Flyer

LPA consulted with applicant regarding COVID-19 health and safety guidelines on this date, applicant was provided forms to post via email. Licensing staff observed COVID- 19 postings posted in the day care on this date. During this inspection LPA discussed PIN 20-06 CCP, Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education. LPA reviewed with the applicant the Child Care Covid-19 Self-Assessment guide that the applicant filled out before this inspection.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FAWAZ FAMILY CHILD CARE
FACILITY NUMBER: 198021081
VISIT DATE: 09/09/2022
NARRATIVE
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Applicant is seeking to provide care for 8 children 2 years – 10 years old. Based upon today’s inspection, the following corrections needs to be completed by 10/1/22.

- Mailbox with post will be made non-moveable
- Applicant will obtain a 2A-10-BC fire extinguisher and provide purchase receipt to LPA
- Applicant will obtain cots to be used for napping children
- A pool gate will be installed that meets licensing requirements and is self-latching, self-closing and self-latching device will be located no more than 6 inches from the top of the gate.
- Alarms will be installed on french doors and windows leading to backyard if deemed necessary by LPM


The application will be submitted for final review to the Department once the corrections have been received. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.


Exit interview conducted and report was reviewed with Applicant, Helen Fawaz.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7