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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500443
Report Date: 07/11/2023
Date Signed: 07/11/2023 11:02:23 AM

Document Has Been Signed on 07/11/2023 11:02 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MAHFOUZ, LAILAFACILITY NUMBER:
344500443
ADMINISTRATOR:MAHFOUZ, LAILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 670-3716
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Laila MahfouzTIME COMPLETED:
11:10 AM
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On July 11, 2023, Licensing Program Analysts (LPA) Jennie Tedlos and Licensing Program Manager (LPM) Bettina Engelman conducted an unannounced 1 Year required inspection and met with Licensee, Laila Mahfouz. LPA observed 4 children supervised by Licensee, Laila Mahfouz, and an adult assistant. Criminal record clearances have been verified. Facility fees were reviewed and are current. Licensee stated there are no new residents in the home since licensure. Licensee operation hours are Monday- Sunday: 5:30 AM-4:30 PM and occasionally provides extended care that results in pick up times at 11:00PM. Rarely does she provide overnight care.

LPA, LPM and Licensee toured the facility during the inspection. Off limit areas are the fenced pool area, garage, laundry room, and the entire upstairs. The backyard is fenced. Licensee recently installed a pool in the backyard and has a wrought iron fence enclosing the pool area. LPA and LPM inspected the fence and created a plan with licensee to add a 5ft fence panel between the house and the fence along the air conditioning unit, and to remove a small portion of the fence to allow for escape upon exiting the window. The fence has a self closing and latching gate. No children are allowed in the backyard until the fencing is completed. Licensee will notify LPA upon completion of the fence and email pictures. Licensee stated there are no weapons in the home.

LPA conducted record reviews during the inspection. Five child files, Licensee, and her Assistants’ files were reviewed. LPAs discussed mandated reporter training with the Licensee. Licensee and her Assistant has current Mandated Reporter Training on file. Licensee understands Mandated Reporter Training is to be completed every two years. Mandated reporter training can be accessed at www.mandatedreporterca.com. CPR/First Aid certification was reviewed for Licensee. Certification expiration date is 5/2024. LPA observed fire drills were conducted at least once every six months and documented.

LPA observed that there were no hazardous items accessible to children. LPAs observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Toys appear to be safe.

REPORT CONTINUED ON SUBSEQUENT PAGE, 809 C
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MAHFOUZ, LAILA
FACILITY NUMBER: 344500443
VISIT DATE: 07/11/2023
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Licensee was reminded that all adults 18 and over, 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 facility. 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.

This facility does not provide Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA Information 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


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.

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.

LPA reviewed report with the Licensee, Laila Mahfouz and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No Title 22 deficiencies observed in the areas evaluated during the inspection.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC809 (FAS) - (06/04)
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