376100406-5-22-2020-51-CC-TBLK-BPUNYQ-20200522105306

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100406
Report Date: 05/22/2020
Date Signed: 05/22/2020 10:53:23 AM

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:	MUSSE, YASMIN FAMILY CHILD CARE		FACILITY NUMBER:	376100406
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/22/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Yasmin Musse		TIME COMPLETED:	10:50 AM

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), Tyra Block, conducted an announced Pre-Licensing tele-inspection for relocation with Yasmin Musse via Facetime due to COVID-19. The single story, 4 bedroom, 2 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher (2A10BC) was not operational the needle on the gauge was in the red/ recharge, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. The fireplace is screened. There is a pool in the backyard with a gate measuring at least 5ft with a see through screen, lock and it is self-latching. Applicant states that the pool gate was recently installed by a professional prior to moving in. Applicant states that there are no weapons in the home. CPR and First Aid expire on 8/31/21. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Staff immunization requirements were met. Applicant rents the home and has obtained landlord consent. Applicant will be using the following rooms for childcare: master bedroom and bathroom, living room, dining room, kitchen, and backyard patio area. Off limits areas include: the pool, 3 bedrooms and hall bathroom on the left side of the home, and the garage. They are inaccessible through the use of child safety gate and doorknob covers/ lever locks. The applicant has sufficient toys and equipment available for school-age children and plans to utilize the YMCA Toy Lending Library for additional toys. The home has a fenced backyard available for outdoor activities. Applicant was reminded of requirements for children’s records, child abuse, and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA provided information regarding Effects of Lead, COVID-19, PIN 20-06, Safe Sleep Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2020

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: MUSSE, YASMIN FAMILY CHILD CARE	FACILITY NUMBER: 376100406
	VISIT DATE: 05/22/2020

NARRATIVE

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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.

Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.Southern California Child Care Advocate information was provided and applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The Applicant was provided a copy of their appeal rights (LIC 9058 12/15) and this report via email. Licensee will send a reply to confirm receipt of these rights.

The following corrections are needed prior to issuance of a license for 8 children:

Fire Extinguisher that is operational and meets minimum requirements

Indoor Facility Sketch with 4 bedroom 2 baths and off limit areas marked

Licensee will submit picture of proof of correction by email to LPA.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2020

LIC809 (FAS) - (06/04)

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