435700351-1-6-2022-52-CC-JMIR-CAERDB-20220106115541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700351
Report Date: 01/06/2022
Date Signed: 01/06/2022 11:56:06 AM

Document Has Been Signed on 01/06/2022 11:56 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GHRAIRI, HALLOUMA		FACILITY NUMBER:	435700351
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/06/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Hallouma Ghrairi		TIME COMPLETED:	12:00 PM

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On 01/06/2022, a tele-visit inspection was conducted by Licensing Program Analyst (LPA) Jaylena Miller due to the COVID-19 Omicron Surge. LPA met with applicant Hallouma Ghrairi for an announced Pre-Licensing Inspection. Present for the inspection was applicant’s minor son. The applicant has applied for an initial Family Child Care Home License. The applicant plans to operate Monday-Friday from 8am-5pm. LPA conducted a health and safety inspection inside and outside with applicant. Parents will enter the home through the back door off Latham Street.

The home is a two-story home with 2 bedrooms, 1 located on the first floor that will be used for daycare, 2 bathrooms, one on the first floor that will be used for the children, a living room, a kitchen with dining area, laundry room located on the second floor, and back patio which is completely fenced in. The home is neat and clean with central heating and ventilation for safety and comfort. During today’s inspection, there is a gate located at the base of the stairs which lead to the second story of the home, and the applicant is aware when children under the age of 5 years old are present in the home in care, the gate must be in place.

The OFF-LIMIT AREAS will be the entire second floor and will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are the first floor bedroom, bathroom, the kitchen and dining area and the back patio. The designated isolation area will be a designated area in the living room near the back patio door. The outdoor play area will be the back patio however applicant would also like to use the nearby park and LPA reminded applicant that 100% physical and visual supervision is required when using the near by park.

All hazardous materials and toxins are kept out of reach from children and would not be accessible to children during care. The kitchen cabinets and drawers have child safety latches and knives and sharp objects are kept out of reach of children. The home has a fully charged 2A-10-BC fire extinguisher, working smoke/carbon monoxide (combo) detector, telephone, and first aid kit. Per applicant, there are no firearms on the premises. There are no pools, hot tubs or any other bodies of water present during the inspection.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GHRAIRI, HALLOUMA	FACILITY NUMBER: 435700351
	VISIT DATE: 01/06/2022

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The applicant has received certificates of completion in Preventative Health and Safety training on 1/9/2021, the mandated reporter training on 7/14/2020, and CPR and First Aid which is current and expires on 12/13/2022. LPA Miller discussed with applicant the CPR/First Aid and Mandated Reporter Training must be renewed every two years and CPR/First Aid needs to be EMSA approved. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. The applicant has proof of the provider immunizations on file.

LPA also discussed with applicant that ALL assistants, Volunteers, frequent visitors, or adults living in the home, over the age of 18, must be fingerprint cleared and associated to the home prior to being in the presence of children in care. An immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter and encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded.

LPAs provided a copy of Safe Sleep Regulation Concept, and Safe Sleep in Child Care brochure, and a handout "What Does A Safe Sleep Environment Look Like?" to the applicant.

The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to CCL. Also, any adults moving into the home must be reported to CCL prior to them moving in and all requirements must be met before the person lives in the facility.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone to CCL Desk Duty Analyst and LIC 624 within 7 business days.

A Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

The applicant was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

For licensing updates please email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GHRAIRI, HALLOUMA	FACILITY NUMBER: 435700351
	VISIT DATE: 01/06/2022

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Individual Medical Services (IMS) policy was discussed. The applicant is reminded that when any changes to the IMS plan is made, an updated 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 website at: http://www.ada.gov/childganda.htm.

This home is recommended for licensing as of 01/06/2022. This report shall remain on file for 3 years. Exit interview conducted with Applicant and a copy of report provided via email. Applicant will print and mail report to CCL at:

1515 Clay Street Suite 1102 Oakland, CA 94612 Attn: Jaylena Miller.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

LIC809 (FAS) - (06/04)

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