435700390-9-1-2023-52-CC-CURE-CV9NKG-20230901103154

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700390
Report Date: 09/01/2023
Date Signed: 09/01/2023 10:32:04 AM

Document Has Been Signed on 09/01/2023 10:32 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	KASSAK, NADINE		FACILITY NUMBER:	435700390
ADMINISTRATOR:	NADINE KASSAK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 470-0768
CITY:	MOUNTAIN VIEW	STATE: CA	ZIP CODE:	94041
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 0	DATE:	09/01/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nadine Kassak		TIME COMPLETED:	10:45 AM

NARRATIVE

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On 09/01/2023 at 9:30am, Licensing Program Analyst (LPA) Christina Uribe met with applicant Nadine Kassak for the purpose of conducting an announced pre-licensing inspection. Present during today’s inspection is the applicant's fingerprint cleared mother and resident of the home, Sabah El Kadamani. The home was toured for a health and safety inspection.

The facility is a single story home consisting of 2 bedrooms, 1 bathroom, living room, kitchen, family room (day care room), dining Room, laundry room, detached garage, & backyard which are neat and clean with heating and ventilation for safety and comfort. The off-limits areas will be made inaccessible by closed and/or locked doors and visual supervision. On-Limit Areas: Bedroom #1, bathroom, living room, family room, dining room, & backyard. Off-Limit Areas: Bedroom #2, laundry room, kitchen & garage.

The outdoor play area is located in the applicant’s backyard and is fully fenced and in good condition with no hazardous materials accessible to children in care. There are no pools, hot tubs, or any other bodies of water present in the on-limit areas during today’s inspection.

There are ample age-appropriate toys that appear to be safe and in good condition. The home is equipped with a fully charged 2A10BC fire extinguisher, functional carbon monoxide detector, smoke detector, & telephone. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There is a fireplace located in the on-limit family room (day care room) that is barricaded to prevent accessibility to children in care.

Per applicant, there are no firearms or pets in the home. The applicant is in compliance with the immunization laws which pertain to all childcare providers. Applicant completed and received certificates for Mandated Reporter Training & Pediatric CPR/First-Aid Training and was reminded of their responsibility to renew each training every two years.

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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KASSAK, NADINE	FACILITY NUMBER: 435700390
	VISIT DATE: 09/01/2023

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LPA reviewed the Packet of Records to be Maintained with applicant.. Applicant understands their responsibility for maintaining personnel and children's records, keeping complete and separate records for each child, and making them available for review upon request to the Licensing Department.

Baby bouncers & drop-down cribs are not allowed at the daycare facility. Roster of children & their records must be properly maintained & available for review at all times. A fire/disaster drill must be performed and recorded every 6 months. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to the Community Care Licensing.

LPA and applicant discussed the capacity requirements for a Large Family Child Care Home license. Applicant understands that she will need to have an assistant when there is more than 8 children in care. When there is no assistant, the applicant will follow the capacity requirements of a Small Family Child Care Home and have no more than 8 children in care.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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/per 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.

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification (LIC 9151) form that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent (LIC 9149) form.

Applicant was informed of the MyChildCarePlan.org site, 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.

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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: KASSAK, NADINE	FACILITY NUMBER: 435700390
	VISIT DATE: 09/01/2023

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Incidental Medical Services (IMS) policy was discussed. At this time, the applicant does plan on providing IMS to children in care. For IMS information, see PIN 22-02-CCP. 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/resources/child-care-centers/.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

On 08/08/2023 the California Attorney General – Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California’s Megan’s Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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.

This home is recommended for Licensure on 09/01/2023. A notice of site visit was given to applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the applicant, Nadine Kassak.

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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

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