364813206-8-29-2023-12-CC-KZIS-CV6VD2-20230829162000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364813206
Report Date: 08/29/2023
Date Signed: 08/29/2023 04:20:10 PM

Document Has Been Signed on 08/29/2023 04:20 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
PALMDALE CHILD CARE, 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: 14	CENSUS: 5	DATE:	08/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Licensee Yasmeen Alsayegh		TIME COMPLETED:	04:30 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 five children ( 1 infant, two preschool, 2 school age) 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 July 2023. The fire extinguisher was serviced in May 2022. LPA advised the Licensee that the fire extinguisher had to be serviced once a year or a new fire extinguisher had to be purchased for the fire extinguisher to meet the State Fire Marshal standards. Safe and age appropriate toys, play equipment and materials were present. Smoke detector and carbon monoxide detector were observed. 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: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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

FACILITY NAME: ALSAYEGH FAMILY CHILD CARE	FACILITY NUMBER: 364813206
	VISIT DATE: 08/29/2023

NARRATIVE

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Report continued from page one

During the tour of the home, LPA observed a loose blanket in a play yard with a awake infant. LPA advised the Licensee that a play yard had to be free of all loose articles and objects. An advisory notice was issued.

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. The front yard is the on limits outdoor play space. The front yard is surrounded by fence. 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.

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 five child files and the Licensees file. Based on LPAs record review of the infant safe sleep records, the Licensee was not recording the time of each 15 minute check as required. A technical advisory notice was issued.

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).

Report continued on page three

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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

FACILITY NAME: ALSAYEGH FAMILY CHILD CARE	FACILITY NUMBER: 364813206
	VISIT DATE: 08/29/2023

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Report continued from page two
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
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

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 two technical violation and one technical assistance was 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: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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