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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021081
Report Date: 10/06/2022
Date Signed: 10/06/2022 11:55:49 AM

Document Has Been Signed on 10/06/2022 11:55 AM - 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:
10/06/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Helen Fawaz, ApplicantTIME COMPLETED:
12:15 PM
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An announced Pre-Licensing Follow-up 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 was to inspect and evaluate corrections requested during the initial pre-licensing inspection on 9/9/22. Applicant is applying for a Small Family Child Care Home. Present during this inspection were Applicant and one year old 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 regarding corrections needed from initial pre-licensing visit on 9/9/22:
- Mailbox with post was made non-moveable by cementing into front yard.
- Applicant obtained a 2A-10-BC fire extinguisher and provide purchase receipt to LPA with purchase date of 9/29/22
- LPA observed 6 cots to be used for napping children
- LPA observed Alarms were purchased and will be installed on french doors and 2 windows leading to backyard if deemed necessary by LPM
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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: 10/06/2022
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Based upon today’s inspection, the following corrections needs to be completed by 10/15/22:

- A pool gate was installed however it does not meet licensing requirements in that it is not self-latching, self-closing, and does not swing away from the pool. Also, self-latching device is located 13 inches from the top of the gate, and exceeds the maximum of 6 inches from the top of the gate.

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

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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