376100139-11-12-2021-51-CC-JLOT-C8PV5F-20211112150752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100139
Report Date: 11/12/2021
Date Signed: 11/12/2021 03:07:59 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:	WARSHAN, MARIAM FAMILY CHILD CARE		FACILITY NUMBER:	376100139
ADMINISTRATOR:	MARIAM WARSHAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 635-8059
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	14	CENSUS: 0	DATE:	11/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:09 AM
MET WITH:	Licensee, Mariam Warshan		TIME COMPLETED:	02:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Jennifer Lott conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Licensee, Mariam Warshan and granted entry after identifying herself and disclosing the purpose of her visit. Licensee's daughter, Adina Nooristani arrived a short time later to provide translating assistance as the licensee speaks Nuristani. The licensee is using the following areas for daycare: Living room, bathroom #2 and backyard. Off limit areas include: Kitchen, front yard, garage, bedrooms 1-4 and bathroom #1. Business Hours are: 6am-11pm Sunday through Saturday. The facility currently has 0 children in care at this time. Licensee provided a copy of their current roster and is operating within the licensed ratio and capacity. At 1:00pm, LPA/Licensee tested the fire alarm/carbon monoxide detector located in the hall/living room area. Both devices were functional. There is no swimming pool or bodies of water on the premises. Licensee states there are no firearms or ammunition stored on the premises. Fireplaces and open face heaters are screened to prevent access by children. There are no stairs in the home. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible to children. Outdoor play area is fenced and free of hazards. The last disaster/fire drill was conducted on 07/09/2021. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer Lott	TELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WARSHAN, MARIAM FAMILY CHILD CARE	FACILITY NUMBER: 376100139
	VISIT DATE: 11/12/2021

NARRATIVE

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Children’s records contained emergency contact information and immunization records. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights. Pediatric CPR and First Aid cards are current and will expire on 07/2022. Mandated Reporter Training is waived as licensee's primary language is Nuristani. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain 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 up to $500.00 maximum per day / per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to: inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on today’s visit, deficiencies were observed and noted on the attached LIC 809D. Exit interview conducted and report was reviewed with the licensee, Warshan. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer Lott	TELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WARSHAN, MARIAM FAMILY CHILD CARE	FACILITY NUMBER: 376100139
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/12/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.2

Reporting Requirements - ...The licensee shall report the following information to the Department by telephone or fax within the Departments next business day and during normal working hours (8am-5pm)... This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's record review, observations and interview with licensee, the licensee did not comply with the section cited above in that they did not report 2 facility closures - 10/14/21 through 10/25/21 and 10/28/21 through 11/05/21. This poses a potential health and safety risk to children in care.
	POC Due Date: 11/26/2021
	Plan of Correction
1 2 3 4	Licensee will submit Unusual Incident Reports for the periods above to CCL by POC date via fax or email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Tashima Daniel	TELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer Lott	TELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WARSHAN, MARIAM FAMILY CHILD CARE	FACILITY NUMBER: 376100139
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/12/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observations, file review and interview with licensee, the licensee did not comply with the section cited above in 1:1 infant's files did not include the 15 minute check log. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/26/2021
	Plan of Correction
1 2 3 4	Licensee states they will complete the infant 15 minute check log and submit to CCL via fax or email by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Tashima Daniel	TELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer Lott	TELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC809 (FAS) - (06/04)

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