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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004032
Report Date: 09/17/2021
Date Signed: 09/17/2021 03:15:08 PM

Document Has Been Signed on 09/17/2021 03:15 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:OUALI, MASSIVAFACILITY NUMBER:
384004032
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:21 AM
MET WITH:Massiva OualiTIME COMPLETED:
10:22 AM
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On September 17, 2021, Licensing Program Analyst (LPA) Sheran Lo arrived at the facility to conduct an unannounced Annual Inspection. LPA met with Licensee Massiva Ouali. Purpose of the inspection was explained. Present were husband, Licensee and six children in care. Per Licensee, the two story apartment is rented and living at home are Licensee, husband, and four children age 3-14 years old. LPA verified the background check clearance of the adults working or living in the home. The hours of operation are: M-F, 8:00 AM – 5:00 PM. Licensee provides breakfast, two snacks, and lunch each day.

Daycare areas: Downstairs Living Room, Dining Room, Bathroom 1, and Upstairs Nap Room. Off Limit areas: Upstairs Bedrooms 2 & 3 and Bathroom 2. LPA and Licensee inspected the entire day care area for Health and Safety hazards. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. There was a combined carbon monoxide and smoke detector in the home. LPA performed the tests to check the functionality of the detector. A fire extinguisher of size 2A10BC or bigger was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there are no firearms or weapons in the home. Licensee states, there are no bodies of water or pets.

LPA observed that the house is in good repair and free of hazards with proper temperature and ventilation. LPA observed that there is a variety of age appropriate toys, books and other learning material available in the home for the children in care. Electric outlets have been secured with child protective covers, and a working phone is on site. Per Licensee, Discipline policy is redirection or communicate about positive behavior practices.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: OUALI, MASSIVA
FACILITY NUMBER: 384004032
VISIT DATE: 09/17/2021
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All posting requirements are met and posted near the day care entrance. Licensee has First Aid CPR that expires 8/23. LPA observed that files have records of immunization, names, addresses and telephone numbers of each child's authorized representative.

LPA reminded Licensee that all adults, 18 years and older living in the home, helper, or assistant must have finger print clearance and must be associated to the facility by submitting an LIC 9182 with a copy of CDL or CA. ID prior to having any contact with children in care, failure to do so could result in an immediate civil penalty.

LPA reminded Licensee that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

LPA reminded Licensee that As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

>NO deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

Notice of site visit shall be posted for 30 days from today's visit. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800.

Report was reviewed and signed by Licensee, Massiva Ouali. Today’s report, September 17, 2021 and notice of site visit will be emailed to massivaouali@gmail.com by close of business. Confirmation of receipt is required.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: Sheran Lo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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