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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624184
Report Date: 06/12/2023
Date Signed: 06/12/2023 09:47:12 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/12/2023 09:47 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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SHAMAL, MURSALFACILITY NUMBER:
343624184
ADMINISTRATOR:SHAMAL, MURSALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 664-8834
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
06/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Mursal and Edrees ShamalTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) met with the licensee, Mursal Shamal, and spouse, Edrees Shamal, for an annual inspection. During the inspection, licensee informed the LPA that since licensee moved to this location, licensee has not started to operate yet. Currently, there are no day care children present during the inspection.

During inspection, LPA discussed the pending fire inspection status with the licensee and her spouse. LPA was informed the licensee will be getting the fire alarm installed today and will have the fire inspector come to the home and provide the clearance. LPA reminded the licensee to obtain and keep the valid EMSA approved CPR training before starting to operate again. Per licensee, there has been no changes in the home since previous inspection. LPA reminded the licensee that all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with copy of CA DL or CA ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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/childqanda.htm

LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at [email protected] and ask to be added to the email list for the updates.


No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2023
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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