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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624231
Report Date: 03/08/2022
Date Signed: 03/08/2022 02:17:36 PM

Document Has Been Signed on 03/08/2022 02:17 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:EZZELDIN, NADAFACILITY NUMBER:
343624231
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Nada EzzeldinTIME COMPLETED:
02:25 PM
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At 12:35 p.m. on Tuesday, March 8th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Nada Ezzeldin, for the purpose of a prelicensing, change of location inspection. Licensee was Licensee was previously licensed at facility #343623352.. Licensee's spouse and children were also present during inspection. All individuals subject to criminal background review have obtained a criminal record clearance.

The single story home consists of 3 bedrooms, 2 bathroom, kitchen, living room and dining room and garage. Off limits area will consist of the Garage. Applicant acknowledges that child care children must never enter the off-limits area. Hours of operation are 7:00 a.m.-7:00p.m, Monday thru Friday. Applicant understands they must live in the home and be present at the facility for 80% of operating hours.

Applicant guided LPA on a tour of the home. LPA observed functioning smoke and carbon monoxide detectors, and a 2A10-BC fire extinguisher. Fireplace in the home had a cover to prevent access by children. Hazardous items were appropriately stored, inaccessible to children. Applicant stated that there are no firearms nor poisons in the home.

The outdoor space is fenced. LPA observed a trampoline and swing in the outdoor space. LPA observed some gaps in the fencing where the wooden fencing had fallen off. LPA observed chain link fencing behind the wooden fencing, and a concrete water run off below. Licensee's spouse made repairs to fencing during inspection. LPA observed a hot tub half filled with water. The hot tub covering and closure devices were no longer connected to the hot tub. Licensee's spouse made repairs to the hot tub covering during inspection. Licensee stated that they plan to remove the hot tub from the property.

Report continues on 809-C.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: EZZELDIN, NADA
FACILITY NUMBER: 343624231
VISIT DATE: 03/08/2022
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Applicant has completed the required Preventative Health and Safety course which includes 1 hour of nutrition. Applicant was reminded to enroll in the lead prevention training course. Applicant's EMSA certified CPR and First Aid certification expired in February, 2021. Licensee enrolled in a CPR course during inspection. Licensee will follow up with LPA to provide proof of completion.

LPA reviewed updated safe sleep regulations. LPA did not observe a crib or play yard at the facility. Licensee understands there shall be one crib or play yard for each infant who cannot climb out of a crib or play yard.

This report was reviewed with the Licensee and an exit interview was conducted. Licensee was encouraged to visit the Department’s website at www.cdss.ca.gov for more information regarding child care updates, forms, regulations and legislation.

As of Tuesday, March 8th, 2022, facility is approved for a PROVISIONAL Small Family Child Care Home license for 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 in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2. Applicant understands that this license will expire in 90 days.


SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC809 (FAS) - (06/04)
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