493010532-6-18-2024-01-CC-ASTR-D6CNHM-20240618102858

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010532
Report Date: 06/18/2024
Date Signed: 06/18/2024 10:29:04 AM

Document Has Been Signed on 06/18/2024 10:29 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	HALAWEH, WAFA FCCH		FACILITY NUMBER:	493010532
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	06/18/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:25 AM
MET WITH:	Wafa Halaweh		TIME VISIT/ INSPECTION COMPLETED:	10:43 AM

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A case management inspection was conducted at the facility by Licensing Program (LPA) Amy Strother in response to an increase capacity application received by the Department on 05/16/24 from Licensee, Wafa Halaweh (L1). The licensee is requesting a capacity of 14. Proof of control of property is on file. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms it was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). The Santa Rosa Fire Department inspected and granted a fire clearance on 06/12/2024. Fire clearance was received by the department on 06/17/24. There is a functional smoke/carbon monoxide detector and a charged fire extinguisher in the facility. The fire pull station is located in the kitchen. The licensee stated she clearly understand the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged, and when an assistant provider must be present. The licensee understands if no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. A review of staff records indicates that all current facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee 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/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.

The facility was toured inside and outside. The facility’s operating hours are 07:30am - 05:30pm, Monday - Friday.

Continue on LIC809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HALAWEH, WAFA FCCH	FACILITY NUMBER: 493010532
	VISIT DATE: 06/18/2024

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The floor plan submitted by the licensee was reviewed and verified. The children will have access to the living room, downstairs bathroom and kitchen. All other areas of the home are off-limits, made inaccessible by child safety gates and a key locked garage. The children use the backyard located out the living room door or the side yard located out the sliding glass door across from the bathroom, as the outdoor play areas, both areas are fully fenced. There is no spa, pool, pond, or fountain on the premises. None shall be added without prior approval of the Licensing agency. L1’s Pediatric CPR and Pediatric First Aid cards expire 04/2025. L1 provided copies of her two assistants Pediatric CPR and Pediatric First Aid cards, which also expire 04/2025.

The increase capacity to 14, as a Large Family Child Care Home is granted as of today, 06/18/24.

An exit interview has been conducted and this report has been reviewed with the licensee, Wafa Halaweh.

Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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