Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627417
Report Date: 03/14/2018
Date Signed: 03/14/2018 12:17:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HAMMO, SALI FAMILY CHILD CAREFACILITY NUMBER:
376627417
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
03/14/2018
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Sali HammoTIME COMPLETED:
12:45 PM
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LPA, Michelle Hood , met with Applicant for the purpose of a Pre-Licensing inspection. Applicant has applied for a change of location on 02/20/2018.

LPA toured the home. It is a two story, three bedroom, two an a half bathroom townhouse. Licensee has her postings located outside of the kitchen area. LPA reviewed the required documents. There is a working telephone on the premises. LPA did not note any hazardous items accessible to children. The fire extinguisher size (2A10BC or larger) meets requirements and is fully charged, located on the kitchen counter. The smoke detector (located in the dining room) and carbon monoxide detector (located in the upstairs hallway) are operational. Applicant’s Pediatric CPR/FA certifications expire on 09/2019. A review of all adults living in this home who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

Applicant will be using the following areas for childcare: back patio, half bathroom (downstairs), living room, dining room, kitchen and upstairs bedrooms 1 & 2. Off limits areas of the home include the master bedroom and bath, have been made inaccessible with the use of a door knob cover. Children will have outdoor play activities in the fully fenced back patio. She understands that supervision is to be in place at all times the play equipment is to be age appropriate. Applicant has a sufficient amount of age appropriate toys, games and books for the children. Applicant was reminded of requirements for children’s records, child abuse reporting, unusual incident reporting, immunizations, criminal background clearance procedures and policies, posting requirements. SIDS, Shaken Baby Syndrome and Incidental Medical Services. Applicant was reminded that walkers, exersaucers, bouncy seats, jumpers, drop side cribs and napping portables are not to be used for day care.

Upon a finial review, a small license maybe granted.
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2018
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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