376100338-5-29-2020-51-CC-NDIZ-BQ3V97-20200529161353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100338
Report Date: 05/29/2020
Date Signed: 05/29/2020 04:14:10 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:	HUSSEIN, SAMIIRA FAMILY CHILD CARE		FACILITY NUMBER:	376100338
ADMINISTRATOR:	SAMIIRA HUSSEIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 405-3442
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	14	CENSUS: 0	DATE:	05/29/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	03:42 PM
MET WITH:	Samiira Hussein		TIME COMPLETED:	04:30 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), Nancy, conducted an announced Pre-Licensing tele-inspection with the applicant Samiira Hussein via Facetime due to COVID19 outbreak. Ms. Hussein was previously licensed at the same location and surrendered her license in October 2019. A new application was received on 1/28/2020. The one-story apartment was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher (2A10BC), carbon monoxide detector and smoke detector meet requirements and are operational. Hazardous items were latched/locked and secured out of reach of children. There are no bodies of water within the premises. Applicant states that there are no weapons in the home. Applicant states that they have sufficient financial resources to sustain the license. A review of staff records on this date indicates that Ms. Hussein has received criminal record and child abuse clearances. Applicant rents the home and has provided Landlord Notification. First Aid and CPR expire on 9/13/2021 and preventative health practices course was completed on 5/1/2016. Mandated Reporter Training was completed on July 2018. Fire Marshall clearance was received on 2/19/2020 for maximum capacity of 14 children (12 children without Landlord consent). Applicant will be using the following rooms for childcare:kitchen, dining area, living room, patio area and bathroom. The bedroom is off-limits to children. The bedroom is kept off-limits via door knob cover. The applicant has sufficient toys and equipment available. Applicant understands that visual supervision is to be maintained during outdoor activities.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2020

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: HUSSEIN, SAMIIRA FAMILY CHILD CARE	FACILITY NUMBER: 376100338
	VISIT DATE: 05/29/2020

NARRATIVE

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The new provider packet was reviewed with the applicant including information on child abuse reporting, children’s records, immunizations, adults living or working in the home, shaken baby syndrome, SIDS and Safe Sleep Regulation, Effects of Lead Exposure, Incidental Medical Services, and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Applicant discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. Information for COVID19 was also provided.

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

A copy of this report is going to be emailed to Ms. Hussein - husseinsamiira@gmail.com. Ms. Hussein shall sign the report and email to Nancy.diaz@dss.ca.gov

No correction is needed. License for a large day care is issued today, May 29, 2020.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2020

LIC809 (FAS) - (06/04)

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