343624096-10-30-2024-03-CC-LPEZ-DAJVLJ-20241030163200

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624096
Report Date: 10/30/2024
Date Signed: 10/30/2024 04:32:07 PM

Document Has Been Signed on 10/30/2024 04:32 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	KHUDAIR, BUDOUR		FACILITY NUMBER:	343624096
ADMINISTRATOR/ DIRECTOR:	KHUDAIR, BUDOUR		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 883-9847
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	10/30/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Budour Khudair		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Loraine Perez met with, Licensee Budour Khudair (Licensee), for an unannounced inspection. At the time of inspection there are two children in care. Present today are Licensee, husband, two adult children, and four minor children who are not counted in capacity. All individuals subject to criminal background review have obtained a criminal record clearance. Facilities hours of operation are Monday through Friday 2:00 PM to 9:30 PM.

A health and safety inspection was conducted in the areas accessible to children. At the time of inspection Licensee requested to change an off-limit area to on limits. LPA approves of the use of the Primary bedroom. New Off limit areas include the primary bathroom, garage, locked shed, both side yards and laundry room. Licensee understands that children may never enter off-limits areas. LPA observed a working telephone, functioning smoke and carbon monoxide detector, and a 2A10BC fire extinguisher within the home. LPA observed the home was safe, orderly, and free of hazards. LPA observed a variety of age-appropriate toys. Licensee stated there are no firearms or bodies of water on the premises. Licensee stated there are no poisons with in the home. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock. LPA observed all required postings, a children's roster, and fire drill log. LPA reviewed records of children’s files and staff files. Missing from two children’s files are copies of the immunization records. A deficiency is cited on LIC809D. Licensee has current EMSA-approved pediatric CPR/First Aid which will expire 10/2025. Licensee understands both CPR/First Aid training must be completed every two years. Licensee is exempt from Mandated Reporter training due to language barrier.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Report continues on LIC809C

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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 10/30/2024 04:32 PM - It Cannot Be Edited

Created By: Loraine Perez On 10/30/2024 at 03:53 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KHUDAIR, BUDOUR	FACILITY NUMBER: 343624096
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Licensee did not ensure that prior to admission to a family day care home that children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/31/2024
	Plan of Correction
1 2 3 4	Licensee stated she shall email copies of immunization records for the two children in care to LPA L. Perez to loraine.perez@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Amanda Blesi

LICENSING EVALUATOR NAME:

Loraine Perez

LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KHUDAIR, BUDOUR	FACILITY NUMBER: 343624096
	VISIT DATE: 10/30/2024

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LPA reviewed with Licensee the safe sleep regulations and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee 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 PIN 22-02- CCP. 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 Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

One Title 22 deficiency is being cited based on today's inspection. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.

Exit interview conducted and report was reviewed with Licensee Budour Khudair. During the exit interview, Licensee Budour Khudair confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Loraine Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC809 (FAS) - (06/04)

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