343624904-4-28-2023-03-CC-KGUA-CRBPF6-20230428111612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624904
Report Date: 04/28/2023
Date Signed: 04/28/2023 11:16:26 AM

Document Has Been Signed on 04/28/2023 11:16 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:	SALEH, BIBI SUMAYA		FACILITY NUMBER:	343624904
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	04/28/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Bibi Sumaya Saleh		TIME COMPLETED:	11:25 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 10:05 a.m. on Friday, October 28th, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Bibi Sumaya Saleh, for the purpose of an announced prelicensing change of location inspection. Applicant is currently licensed at facility 343624105. Applicant understands that when location change license is approved the old facility will be closed and care can no longer take place at that location. Applicant's children and spouse were also present during inspection. Applicant's spouse and Language Link services provided translation assistance in Applicant's preferred language of Dari. Facility operating hours will be from 6:00 a.m. - 6:00 p.m., Monday thru Friday. All individuals subject to criminal background review have obtained a criminal record clearance. 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. Applicant guided LPA on a tour of the facility. The two story home consists of 4 bedrooms, 2 bathrooms, kitchen, living room, and backyard. Off limits areas will consist of spouse's bedroom. Applicant acknowledges that child care children must not enter these off limits areas of the home, and their own children under 10 years will count toward the childcare ratio when present during operating hours. LPA observed a 2A10-BC fire extinguisher and functioning smoke and carbon monoxide detectors. LPA reviewed the required postings. Cleaning materials, hazardous items, and medications are all stored inaccessible to children. Applicant stated that there are no weapons nor poisons in the home. Report continued on 809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: SALEH, BIBI SUMAYA	FACILITY NUMBER: 343624904
	VISIT DATE: 04/28/2023

NARRATIVE

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Stairs in the home were not fenced or barricaded. There is a pool in the backyard. Water has been drained. LPA observed fencing surrounding the pool that is at least 5 feet tall. Gate was not self latching. Latch for gate was greater than 6 inches from the top of the pool fencing. LPA reviewed civil penalties regarding bodies of water citations that can occur once the facility is licensed. Applicant understands that 100% supervision is required around bodies of water or in unfenced areas.

Applicant owns the home and provided proof of control of property via home title paperwork during inspection. Applicant has completed the required Preventative Health and Safety course. Applicant's current in person EMSA approved CPR and First Aid certification expires on November, 2023. Applicant was reminded that CPR/First Aid certification shall be renewed every two years.

Licensee was reminded that once licensed they shall ensure that children are supervised at all times. Licensee understands that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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. LPA reminded Applicant that cribs or play yards shall be free of loose articles and objects and that bassinets shall not be used.

The following corrections are required prior to licensure:

1. Pool gate shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate.

2. Stairs in the home shall be fenced or barricaded to prevent access.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

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