376100533-11-5-2020-51-CC-KLAE-BV3UAW-20201105142524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100533
Report Date: 11/05/2020
Date Signed: 11/05/2020 02:26:23 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:	HASSAN, ASHA FAMILY CHILD CARE		FACILITY NUMBER:	376100533
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	11/05/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Asha Hassan		TIME COMPLETED:	10:00 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	On 11/5/2020 at 8:45 AM, Licensing Program Analyst (LPA) Keturah Lane conducted an announced Pre-Licensing tele-inspection due to COVID-19 for relocation with the applicant. The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke detector meet requirements and are operational. Applicant does not have a carbon monoxide detector installed. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home. Applicant states that there are no weapons in the home. CPR and First Aid expire on 1/19/21. Preventative Health course was completed on 8/11/19. Applicant completed Lead Poison prevention training on 8/21/20. 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 has a first aid kit but does not have a thermometer to check the children’s temperature. Applicant rents the home. Applicant will be using the following rooms for childcare: living room, dining room, kitchen, bedroom #1 (also known as children’s room) and bathroom. Off-limits areas include: Master bedroom/bath and bedroom #2 and are inaccessible through the use of door-knob covers and locks. The applicant has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. There is a hole in the side fence that needs repairing. Also, there is a small finished storage shed in the backyard that is off-limits and has a key-lock. Applicant stated it would be locked when children are present. 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. (continued on LIC809-C...)

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020

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: HASSAN, ASHA FAMILY CHILD CARE	FACILITY NUMBER: 376100533
	VISIT DATE: 11/05/2020

NARRATIVE

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LPA provided information regarding Safe Sleep Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA reviewed COVID-19 guidelines briefly as tele-visit was completed with LPA Gargaro on 8/20/20 at previous facility.

Applicant stated she will be applying for a large family care license. The applicant’s home appears large enough to comfortably accommodate a large license capacity. Licensee understands that procedure for applying for a large license must first be completed.

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.

Corrections needed before license can be granted:
1. Carbon monoxide detector installed – Applicant will send video of test
2. Obtain a thermometer to check children’s temperature – Applicant will send picture of thermometer OR receipt of purchase
3. Repair broken fence on side of backyard – Applicant will send picture of repaired fence.

Once proof of corrections are sent via e-mail to LPA Lane, a license for a small family child care will be granted.

An exit interview was conducted with applicant. A Notice of Site Visit (LIC9213) and Appeal Rights (LIC9058) will be sent along with the report (LIC809) via e-mail to the Licensee. Licensee will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights. The Notice of Site Visit (LIC9213) must remain posted for 30 days.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah Lane	TELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020

LIC809 (FAS) - (06/04)

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