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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624962
Report Date: 05/09/2023
Date Signed: 05/09/2023 10:17:30 AM

Document Has Been Signed on 05/09/2023 10:17 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:ABDULHAMEED, SAMARFACILITY NUMBER:
343624962
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/09/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Samar AbdulhameedTIME COMPLETED:
10:30 AM
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At 9:00 a.m. on Wednesday, May 3rd, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Samar Abdulhameed, for the purpose of an announced prelicensing change of location inspection. Applicant was previously licensed at facility 343623826. Applicant understands that once licensed, the old facility will be closed and care can no longer take place at that location. Facility operating hours will be from 7:00 a.m. - 12:00 a.m., 7 days a week.

LPA did not observe criminal record clearance for spouse. 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 single story family home consists of 3 bedrooms, 2 bathrooms, kitchen, living room, dining room, garage, and backyard. Off limits areas will consist of garage, master bedroom/bathroom and the side portion of the backyard. 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. Cleaning materials, hazardous items, and medications are all stored inaccessible to children. There are no bodies of water on the premises. The off limits side portion of the backyard is in process of repairs. LPA observed trench diggings. 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: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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: ABDULHAMEED, SAMAR
FACILITY NUMBER: 343624962
VISIT DATE: 05/09/2023
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LPA reviewed overnight care regulations and smoking prohibition. Capacity change application process was discussed. TB clearance is needed for spouse.

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.

Applicant rents the home and provided proof of control of property via lease agreement. Landlord consent is on file with the department. Applicant has completed the required Preventative Health and Safety course. Applicant's current in person EMSA approved CPR and First Aid certification was verified and expires on October, 2024. Applicant was reminded that CPR/First Aid certification shall be renewed every two years.

Applicant 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.

The following corrections are needed prior to licensure:



1. Licensee shall provide proof of TB clearance for all adults residing in the home.

2. All adults residing in the home shall obtain criminal record clearance.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC809 (FAS) - (06/04)
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