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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624236
Report Date: 04/11/2023
Date Signed: 04/11/2023 03:20:47 PM

Document Has Been Signed on 04/11/2023 03:20 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ALUBAYDI, IMANFACILITY NUMBER:
343624236
ADMINISTRATOR:ALUBAYDI, IMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 717-4222
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
04/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Saina SandohchiTIME COMPLETED:
03:30 PM
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On April 11th, 2023 Licensing Program Analyst (LPA) Mandie Goodwin met with assistant Saina Sandoghchi, for the purpose of an unannounced required 1-year inspection. LPA spoke on the phone to licensee Iman Alubaydi who stated that she was taking her daughter to a driving test and that it had just finished and she would join shortly. Licensee arrived at the home approximately 30 minutes into inspection. There were no other adults at the time of visit. All individuals subject to criminal background review have obtained a criminal record clearance. LPA observed 7 children during inspection, including 1 infant. Facility days and hours of operation are Monday through Friday from 7:30 AM until 5:30 PM.

LPA toured the facility and a health and safety inspection was conducted in all areas accessible to children. The off-limits areas include the entire upstairs, laundry room, left side of yard- which is gated, and the garage. Licensee acknowledged that children must never enter these areas. LPA observed the required postings, a fully charged fire extinguisher, and smoke and carbon monoxide detectors. There is a weapon upstairs, which was observed to be locked and stored appropriately. Per assistant, there is no ammunition kept in the household. No bodies of water were observed today. Toxic and hazardous items are inaccessible to children. Outdoor play space is fenced and outdoor equipment is in good repair.

LPA reviewed a sample of 4 children’s files which were observed to contain Identification and Emergency information, consent to medical treatment form, notification of parents rights form, immunization records, and the affidavit regarding liability insurance. A current children’s roster was observed. Licensee has record of conducting fire drills at least every six months. Per record, last drill was conducted on 4/10/23. Licensee and assistant files were observed to be complete. LPA observed licensee’s CPR and First Aid card which expires February 2024. Assistant CPR expired 3/25/25.

Continued on 809-C
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ALUBAYDI, IMAN
FACILITY NUMBER: 343624236
VISIT DATE: 04/11/2023
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LPA discussed the requirement of renewing mandated reporter training every 2 years. Licensee’s Mandated Reporter Training is current and expires 1/18/24. Assistant’s mandate reporter training expires 6/9/24. LPA reviewed and provided the Family Child Care Home Entrance Checklist.

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 submitting 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: http://www.ada.gov/childqanda.htm



To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee 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.

LPA discussed the safe sleep regulations with licensee 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 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.

During today’s inspection, no deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with licensee Iman Alubaydi.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
LIC809 (FAS) - (06/04)
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