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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500616
Report Date: 01/10/2024
Date Signed: 01/17/2024 11:11:17 AM

Document Has Been Signed on 01/17/2024 11:11 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:AWADALLA, MANALFACILITY NUMBER:
394500616
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
01/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Manal AwadallaTIME COMPLETED:
02:00 PM
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This is an amend version of a report originally signed on 01/10/2024.

Licensing Program Analyst (LPA) Erwin Tjhia met with Licensee Manal Awadalla for the purpose of a case management inspection. The purpose of today's visit is to verify the swing on the backyard is safe and securely anchored to the ground. Census at the time of inspection were five children. Licensee's operating hours are Monday through Friday from 6:30 AM to 6 PM.

All individuals subject to criminal background review have obtained a 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.

LPA tour the backyard and observe no hazardous items accessible for the children. LPA also observed that the swing equipment is not secured to the ground. LPA tested the structure, and found the support beams was not safely in the ground and moving. The swing set's instruction says that it accommodate children from the age of 3 to 8 years of age. LPA advised licensee to move the swing from the backyard and not to let the children to use it.

This facility evaluation report was reviewed and discussed with Licensee. A notice of site visit was provided and posted, and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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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