376620252-8-17-2022-20-CC-LGAO-CHDVNT-20220817163540

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376620252
Report Date: 08/17/2022
Date Signed: 08/17/2022 04:36:00 PM

Document Has Been Signed on 08/17/2022 04:36 PM - It Cannot Be Edited

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:	WARSAME, ABDIKARIM FAMILY CHILD CARE		FACILITY NUMBER:	376620252
ADMINISTRATOR:	ABDIKARIM WARSAME		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 262-1551
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 0	DATE:	08/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Abdikarim Warsame		TIME COMPLETED:	04:45 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	On August 17, 2022, at 1:30PM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the licensee, Abdikarim Warsame. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee.'s cleared and associated father, Dahir Muse. Mr. Warsame arrived within 15 minutes and met with analyst. No children were present in the facility during this inspection. This facility is a two floor, four bedrooms, two and 1/2 bathroom house. Licensee accompanied LPA inside the facility during this inspection. The following areas used for child care are: the kitchen, the dining area, the living room, the family room and the day care bathroom. Off limits areas are the garage and the entire upstairs. The garage is inaccessible through use of a locking door handle and also a door knob cover installed on the entry door knob. The upstairs is made inaccessible with a child safety gate that is installed when day care children are present. Licensee has a fire place in the family room which is inoperable but is made inaccessible with a board in front of it and a furniture barricade. The fire extinguisher and combination smoke and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has sufficient day care equipment available. The home has a fenced backyard that is off limits. The yard is made off limits with a latching sliding patio door. The door also has a safety alarm installed on it to further prevent children from accessing the off limits yard. Licensee instead takes children to a local park for outdoor activity whenever it is needed. No bodies of water observed on the premises during the inspection. Licensee stated there are no weapons in the home. 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. Licensee’s and helper parent, Asha Abdi's First Aid and CPR certifications both expire on August of 2023. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 03/27/22 while Ms. Abdi is currently exempt from Mandated Reporter Training. Licensee did not have a current facility roster. The last fire and disaster drills have not been documented within the past six months. Licensee currently has no infants in care but analyst provided him with a copy of the safe sleep regulations for him to review at a future date.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

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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Document Has Been Signed on 08/17/2022 04:36 PM - It Cannot Be Edited

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: WARSAME, ABDIKARIM FAMILY CHILD CARE	FACILITY NUMBER: 376620252
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)1

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst observation, the licensee did not comply with the section cited above as he did not have a current fire and disaster drills logged for at least the last six months which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 08/24/2022
	Plan of Correction
1 2 3 4	Licensee states he will conduct both fire and earthquake drills with the day care children in the next week and send analyst a copy of the logged drills by 08/24/22 to complete the correction.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/17/2022 04:36 PM - It Cannot Be Edited

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: WARSAME, ABDIKARIM FAMILY CHILD CARE	FACILITY NUMBER: 376620252
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst record review, the licensee did not comply with the section cited above as he did not have a copy of his helper mother's DTaP immunization on file in the home which is a potential health, safety or personal rights risk to children in care.
	POC Due Date: 09/19/2022
	Plan of Correction
1 2 3 4	Licensee states he will obtain a copy of the missing shot record or have his mother receive an updated vaccination and send a copy of the shot record to analyst by 09/19/22 to complete the correction.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst record review, the licensee did not comply with the section cited above when he did not have record files for some current children which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 08/29/2022
	Plan of Correction
1 2 3 4	Licensee states he will follow up with parents and have records completed for his day care children and then submit copies of two completed sample record files of his choice to analyst by 08/29/22 to complete the correction.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/17/2022 04:36 PM - It Cannot Be Edited

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: WARSAME, ABDIKARIM FAMILY CHILD CARE	FACILITY NUMBER: 376620252
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst record review, the licensee did not comply with the section cited above as he did not have a current roster on file which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 08/24/2022
	Plan of Correction
1 2 3 4	The licensee states that he will complete a roster reflecting all the children he has in care and submit it to analyst by 08/24/22 to complete the correction.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: WARSAME, ABDIKARIM FAMILY CHILD CARE	FACILITY NUMBER: 376620252
	VISIT DATE: 08/17/2022

NARRATIVE

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LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov

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.

Four type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC809 (FAS) - (06/04)

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