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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700351
Report Date: 04/04/2024
Date Signed: 04/04/2024 12:59:42 PM

Document Has Been Signed on 04/04/2024 12:59 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GHRAIRI, HALLOUMAFACILITY NUMBER:
435700351
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
04/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Hallouma GhrairiTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 04/04/2024 at 10:00am Licensing Program Analyst (LPA) Christina Uribe, met with licensee Hallouma Ghrairi for an UNANNOUNCED ANNUAL INSPECTION. Present for the inspection were 4 daycare children and 1 fingerprint cleared assistant (Aline Tilet), and the licensee is within ratio today. Upon arrival LPA provided licensee a copy of the Entrance Checklist (LIC 126). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday-Friday 8:30am-5:00pm.

The home is a two story home with 2 bedrooms, 2 bathrooms, living room, and kitchen. LPA observed the home to be neat and clean with central heating and ventilation for safety and comfort. All on/off-limit areas are consistent with the facility's pre-licensing reports. The home is located in the Verve Apartment Complex.

The OFF-LIMIT AREAS are the entire upstairs which consists of a bedroom and bathroom and are inaccessible to children by locked doors, safety gates and visual supervision. There is a safety gate which is closed and securely installed at the bottom of the stairs.

The ON-LIMIT AREAS are the kitchen, living room, downstairs bathroom, & downstairs bedroom.

The facility's apartment complex does have a communal outdoor pool and game room for children located on the premises, however, the licensee will not be utilizing either of these spaces at any time for her day care. All outdoor activities will take place on the licensee's fenced porch or a nearby park within walking distance. Licensee understands her responsibility for 100% supervision during these times outside of the home. There are no other bodies of water present at the time of the inspection.

All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, carbon monoxide detector, telephone and fully stocked first aid kit. Per licensee, there are no firearms on the premises or pets in the home.

Page 1 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GHRAIRI, HALLOUMA
FACILITY NUMBER: 435700351
VISIT DATE: 04/04/2024
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The licensee completed the Health and Safety training, CPR/First Aid certification expires on 05/07/25. The licensee is in compliance with the immunization laws and has completed the mandated reporter training on 07/04/23. Licensee is reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. The licensee conducts and documents fire and disaster drills twice a year and the last conducted drill was on 12/11/23. All required forms are posted and visible for public review.

Records: LPA Uribe reviewed 4 children’s files and personnel records. Individual Infant Safe Sleep Plans are complete and in child's file. Sleep Charts for sleeping infants were reviewed and within compliance of the Safe Sleep Regulations. There is a current roster available for review and copy obtained. The facility does not have liability insurance and Affidavit Regarding Liability Insurance forms (LIC 282) were reviewed. Staff interview also conducted and documented.


Provider Information Notices (PINs) & Quarterly Updates: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders, by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.
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.
Safe Sleep: 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.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GHRAIRI, HALLOUMA
FACILITY NUMBER: 435700351
VISIT DATE: 04/04/2024
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Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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/resources/child-care-centers/.

MyChildCarePlan.org: 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.

Megan’s Law: During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care 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 to the regional office by phone and the written report, LIC 624, within 7 business days.

No deficiencies cited during today's inspection. Two Advisory Notes (TV) issued.

  • Advisory Note (TV): Licensee is reminded to keep up with obtaining updated immunization records for children as needed.
  • Advisory Note (TV): Licensee is reminded to obtain updated immunization records for assistants.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee, Hallouma Ghrairi.

Page 3 of 3 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024
LIC809 (FAS) - (06/04)
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