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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624096
Report Date: 10/05/2021
Date Signed: 10/05/2021 11:18:54 AM

Document Has Been Signed on 10/05/2021 11:18 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KHUDAIR, BUDOURFACILITY NUMBER:
343624096
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/05/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Budour KhudairTIME COMPLETED:
11:45 AM
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At 10300 a.m. Licensing Program Analysts (LPA) Amanda Blesi met with applicant Budour Khudair and her son for a pre-licensing inspection. Also present was one minor child and licensee's spouse. Prior to entering the home, a COVID-19 Risk Assessment was conducted over the phone with applicant. Applicant has requested a small Family Childcare License to serve up to eight children. LPA toured the home inside and outside. Facility is a one-story house that consists of 3 bedrooms, and 2 bathrooms. Off-limit areas consist of master bedroom/bath, 2nd bedroom, laundry room and garage. Applicant understands that children may never enter the off-limit areas. The back yard is fully fenced, and applicant understands that 100% supervision is required in outside areas that are not fully enclosed by a fence. There is a locked shed in the backyard. There are no bodies of water observed in on the property. All adults residing in the home have received a criminal record clearance.

Applicant 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

Applicant provided a lease agreement or mortgage statement for control of property. Applicant understands that until a liability insurance coverage in the amount of $300,000 is provided, the affidavit form LIC282 form will be used. Applicant submitted proof of current CPR/First Aid (expiring 2024) and completion of Preventative Health and Safety Training. Applicant understands she must be present at the facility for 80% of operating hours.

LPA provided and discussed the Lead Testing brochures (AB 2370).

(Continued on following page....LIC 809-C)

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: KHUDAIR, BUDOUR
FACILITY NUMBER: 343624096
VISIT DATE: 10/05/2021
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LPA discussed the safe sleep regulations with licensee Budour and her son. LPA 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 licensee [facility representative] 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.

LPA did not observe a crib in the home. Licensee does not plan to care for infants. LPA discussed that if Licensee will be providing care to infants, there shall be one infant crib or play yard for each infant who is unable to climb out of the crib or play yard.

This facility does not plan to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. A Plan of Operation that includes 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) 513-0301 (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.ht

This facility evaluation report was reviewed and discussed with the applicant. LIC 311D, records, postings, and reporting requirements were discussed. LPAs discussed supervision, personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the applicant can request to be added to the distribution list to receive Quarterly Updates.

Effective today, a License is issued to serve a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child enrolled in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2. Applicant did not receive landlord consent, and she acknowledges that without consent, she may provide care for a maximum of six children.
Exit interview conducted and report was reviewed with the licensee Budair.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
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