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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619917
Report Date: 10/19/2023
Date Signed: 10/19/2023 02:40:50 PM

Document Has Been Signed on 10/19/2023 02:40 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MAJU, FATMATA BINTAFACILITY NUMBER:
343619917
ADMINISTRATOR:MAJU, FATMATA BINTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 896-8657
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 2DATE:
10/19/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Fatmata Binta MajuTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Corina Beckby met with Licensee, Fatmata Binta Maju on 10/19/23 for the purpose of an unannounced plan of correction inspection to clear the Type B deficiencies, which were issued on 08/31/2023.

Licensee was supervising 2 children during today’s visit. LPA toured the facility and reviewed files.



Licensee observed a gate at the bottom of the stairs. Licensee was reminded that the gate must stay in place while children are present. LPA observed child proof locks in bathroom cabinet and cabinet under kitchen sink. Licensee was reminded locks need to be in working order and must be replaced immediately if broken. LPA observed a current roster and fire drill log. Last fire drill was done on 9/6/23. LPA observed immunization's including flu, for assistant and Licensee. Proof of immunization's for all children enrolled were observed in each child’s file. LPA was provided a new updated application with all adults living in the home.

LPA observed mandated reporter certificate which expires on 10/03/25 and current CPR which expires on 10/05/25, for Licensee. Assistant has not met these requirements.

In the areas that were evaluated, 2 Type B citations were issued that are a potential Health and Safety, or Personal Rights risk to persons in care. A separate 809D is issued for the deficiency.

9 out of 11 Deficiencies cited on 08/31/2023 are cleared effective today, 10/19/2023. Proof of correction letters were provided to Licensee. An Exit interview was conducted, and the report was reviewed with Licensee, Fatmata Binta Maju. LPA posted a notice of site visit. Licensee understands the Notice must remain posted for 30 days and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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 2
Document Has Been Signed on 10/19/2023 02:40 PM - It Cannot Be Edited


Created By: Corina Beckby On 10/19/2023 at 02:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MAJU, FATMATA BINTA
FACILITY NUMBER: 343619917

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2023
Section Cited
HSC
1596.8662(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...
This requirement is not met as evidenced by:
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Licensee will email LPA mandated reporter training no later than due date.
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Based on record review, the licensee did not comply with the section cited above in that assistant did not complete Mandated Reporter Certificate (AB1207), which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
11/20/2023
Section Cited
CCR102416(c)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
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LIcensee will email LPA by due date, proof of recgognized CPR and Frist Aid class, and Prevenetative Health class, (courses given by American Heart Association or EMSA certified agency).
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Based on record review, the licensee did not comply with the section cited above in that assistant does not have a current CPR & First Aid certficate (recognized by department), which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bettina Engelman
LICENSING EVALUATOR NAME:Corina Beckby
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
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