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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393609557
Report Date: 11/06/2024
Date Signed: 11/06/2024 03:50:48 PM

Document Has Been Signed on 11/06/2024 03:50 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MUTAKABBIR, KHALIFAHFACILITY NUMBER:
393609557
ADMINISTRATOR/
DIRECTOR:		MUTAKABBIR, KHALIFAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 662-0686
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Mutakabbir, KhalifahTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On November 6th, 2024, at 1:45 PM, Licensing Program Analyst (LPA), David Nguyen met with licensee, Khalifah Mutakabbir for the purpose of an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. LPA was granted entry into the facility by licensee. There were five (5) children present at the time of inspection. Licensee's operating hours are Monday through Friday from 6:30 AM. to 6:30 PM. Meals—breakfast, AM snack, lunch, PM snack, and dinner—are provided to daycare children. Filtered water from refrigerator is provided to daycare children for drinking water. LPA verified the annual fees are current.

All adults subject to criminal background review have obtained criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

A health and safety inspection was conducted in all areas accessible to children. The detached two-story and single- family home consists of three (3) bedrooms, one and half (1.5) bathrooms, a basement, and a detached 2-car garage. The off-limits areas in the home are the entire upstairs, bedroom 1 and bedroom 2 downstairs, the basement, and the detached 2-car garage in the backyard. Off-limits areas will remain inaccessible to children by locked doors, baby gate, and SUPERVISION. LPA observed the required postings and a working phone. 2A10BC fire extinguisher meets regulations. LPA observed smoke and carbon monoxide detectors, and verified they were both functional. LPA toured the kitchen area and verified knives and cleaners were inaccessible to children in care. Licensee stated there are no weapons in the home. There are no bodies of water on the premises. LPA observed a restroom and verified that hazardous and toxic items were inaccessible to children in care.


Report continues on LIC809-C...(Page 2)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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: MUTAKABBIR, KHALIFAH
FACILITY NUMBER: 393609557
VISIT DATE: 11/06/2024
NARRATIVE
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Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. The last fire drill was conducted and logged on 8/1/2024. Licensee's immunization records for measles (MMR), pertussis (Tdap), and the flu are available in the facility file. Current in-person EMSA pediatric CPR and First Aid certification was verified and expires on 1/20/2026. Licensee has a current Mandated Reporter Training Certificate that expires on 3/12/2025.

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. LPA discussed the requirement to check and log infant napping every 15 minutes, for infants under 24 months. LPA provided a copy of LIC 9227 Individual Infant Sleeping Plan, for infants under 12 months. LPA also discussed with licensee the requirement to complete LIC9227--Individual Infant Sleeping Plan for Infants under twelve months.

This provider is not currently providing Incidental Medical Services (IMS) services to children in care. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at
https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
Report continues on LIC809-C...(Page 3)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
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: MUTAKABBIR, KHALIFAH
FACILITY NUMBER: 393609557
VISIT DATE: 11/06/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, Khalifah Mutakabbir confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation, and regulation information.

Exit interview conducted and report was reviewed with the licensee, Khalifah Mutakabbir. Appeal rights and a notice of site visit were provided. A notice of site visit was posted and must remain posted for 30 days. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, LPA Nguyen informed licensee, Khalifah Mutakabbir that this report dated (11/06/2024) documents one (1) Type-B citation during today’s inspection.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
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Document Has Been Signed on 11/06/2024 03:50 PM - It Cannot Be Edited


Created By: David Nguyen On 11/06/2024 at 03:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MUTAKABBIR, KHALIFAH
FACILITY NUMBER: 393609557

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of two which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/06/2024
Plan of Correction
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Licensee agrees to create sleep logs, conduct 15-minute checks, and log the 15-minute checks onto the sleep logs for infants under 24 months while they nap or sleep. Licensee also agrees to submit LPA the Infant 15-minute sleep logs by the due date of POC (12/6/2024).
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2024


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