364813206-8-9-2022-12-CC-KZIS-CH5RFA-20220809125850

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364813206
Report Date: 08/09/2022
Date Signed: 08/09/2022 12:58:59 PM

Document Has Been Signed on 08/09/2022 12:58 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	ALSAYEGH FAMILY CHILD CARE		FACILITY NUMBER:	364813206
ADMINISTRATOR:	ALSAYEGH, YASMEEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 475-8326
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92404
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 2	DATE:	08/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Yasmeen Alsayegh		TIME COMPLETED:	01:00 PM

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	Licensing Program Analyst (LPA) Zirbes met with Licensee, Yasmeen Alsayegh who guided analyst on a tour of the facility for the one year required inspection. This is single story home with three bedrooms, two bathrooms, kitchen, dining room, living room, front/backyard and detached garage. Per Licensee the living room, dining room, kitchen, one bedroom (toy room), hallway bathroom and front yard are utilized for the family child care activities. Per licensee off-limit areas of the home are two bedrooms, the master bathroom, the detached garage and the backyard. The off limits areas were inaccessible via key locked door knobs. The door leading to the backyard was locked at the time of this inspection. Upon arrival, LPA observed two children in care with the Licensee providing supervision. Licensee was operating facility within ratio during the time of inspection. Currently living in the home is the Licensee. All adult are associated and have eligible clearances. Current days and hours of operation are Monday through Sunday 24 hours a day. Physical Plant: The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medicines and hazardous items that can pose a danger to children. LPA observed cleaning products in the cabinet under the kitchen sink. The cabinet was equipped with a key lock therefore the chemicals were inaccessible to the children in care. Per recorded documentation Fire/earthquake drills were last completed in May 2022, the fire extinguisher was serviced in May 2022. Safe and age appropriate toys, play equipment and materials were present. The smoke detector and carbon monoxide detector were operable. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. The living room is the designated area for ill children in the child care. Report continued on page two

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ALSAYEGH FAMILY CHILD CARE	FACILITY NUMBER: 364813206
	VISIT DATE: 08/09/2022

NARRATIVE

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Report continued from page one

Per Licensee, there are zero firearms stored in the home. A fire place is not present in the home. The home has zero window blinds.
Bathroom: Toilet, sink, faucet were clean and operable. The following were inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish.

Outdoor: Per licensee children do not use the backyard. Children utilize the front yard for active play. The front yard is surrounded by chain link fencing that is at least 5 ft. The front yard is dirt/grass landscaping. There is a grassy area for active play. LPAs observed a large climbing structure with a slide, two swings. The climbing structure was securely anchored to the ground. LPA also observed a octagon climbing structure and a basketball hoop. There were zero bodies of water on the premises at the time of this inspection.

Per Licensee, the family has zero household pets.

CPR/First Aid expires 05/27/2024 and mandated reporter training expires on 06/27/2024.

Review of records to be maintained: LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.
LPA reviewed six child files and the Licensees file. Based on LPAs record review the household, staff and child files were complete and included all required information.

Documents Provided and/or Discussed: Fire Drill Log, Roster, Postings.
The following were observed: Notification of Parents' Rights (PUB394), Roster (LIC9040), License, Emergency and Disaster Information (LIC610A).

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 submitted 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

Report continued on page three

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ALSAYEGH FAMILY CHILD CARE	FACILITY NUMBER: 364813206
	VISIT DATE: 08/09/2022

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Report continued from page two

The following was discussed with the licensee:

Licensee reminded that 100% supervision is required at all times to children in care. Licensee was made aware that it is he/her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified

The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.

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.

Based on LPAs record review there were zero citations issued today.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Yasmeen Alsayegh.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

LIC809 (FAS) - (06/04)

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