376623856-9-8-2021-20-CC-TVUU-C86RAB-20211026125046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 376623856
Report Date: 09/08/2021
Date Signed: 09/08/2021 04:45:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2021 and conducted by Evaluator JoAnn R Legaspi

PUBLIC

COMPLAINT CONTROL NUMBER: 20-CC-20210813102133

FACILITY NAME:	HAYDER, SAHRA FAMILY CHILD CARE		FACILITY NUMBER:	376623856
ADMINISTRATOR:	HAYDER, SAHRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 565-4745
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 8	DATE:	09/08/2021
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Sahra Hayder		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee doesn't have proper day care child's enrollment paperwork

INVESTIGATION FINDINGS:

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On September 8, 2021 at 2:50 PM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a complaint inspection regarding the above allegation. LPA advised Licensee Sahra Hayder of the meeting’s purpose and was granted facility entry. Present in the daycare were one (1) infant (0-24 months), five (5) toddlers (24 months to 5 years), two (2) schooled aged children, two (2) helpers and the Licensee. One child was the Licensee's biological child.

LPA completed a facility inspection, reviewed facility files, interviewed a daycare parent, staff and the Licensee. The Licensee and Staff 1 informed LPA that there are no facility child records file for Child 1. (See LIC 811 Confidential Names). LPA observed there are no facility child records file for C1.

Based on the information obtained during interviews and observations, the allegation that the “Licensee does not have proper daycare child enrollment paperwork” has been determined valid because the preponderance of the evidence has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 20-CC-20210813102133

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HAYDER, SAHRA FAMILY CHILD CARE	FACILITY NUMBER: 376623856
	VISIT DATE: 09/08/2021

NARRATIVE

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of Regulations, (Title 22, Division 12, Chapter 3) the deficiency is being cited on the attached LIC 9099D.

A Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days. Licensee was directed to post this document. An exit interview was conducted with the Licensee. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to the Licensee and their signature on this form confirms receipt of these rights.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC9099 (FAS) - (06/04)

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Control Number 20-CC-20210813102133

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HAYDER, SAHRA FAMILY CHILD CARE	FACILITY NUMBER: 376623856
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/17/2021 Section Cited CCR 102417(g)(7)	1 2 3 4 5 6 7	Operation of a Family Child Care Home - “The home shall be free from … conditions which might endanger a child. Safety precautions ... include … 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 .... to be contacted	1 2 3 4 5 6 7	Licensee agrees to provide LPA with a written signed and dated statement acknowledging the need for complete facility files for children before they start care. Licensee also agreed to write a list of which licensing forms are needed
	8 9 10 11 12 13 14	in an emergency ... the parent's ... consent to emergency medical care.” This requirement is not met as evidenced by: Licensee and Staff told LPA that C1 lacked any written facility records. Based on interviews, file reviews and observations Licensee failed to ensure C1 had any facility written records, which poses as a potential risk to children in care.	8 9 10 11 12 13 14	in the facility before the daycare child begins care. Licensee agreed to provide this written statement to LPA no later than 09/17/2021.
Type B CCR	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	8 9 10 11 12 13 14		8 9 10 11 12 13 14

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: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC9099 (FAS) - (06/04)

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