376624483-8-18-2022-51-CC-PMAA-CHET83-20220818142939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376624483
Report Date: 08/02/2022
Date Signed: 08/18/2022 02:29:45 PM

Document Has Been Signed on 08/18/2022 02:29 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:	AHMED, MUHUBO FAMILY CHILD CARE		FACILITY NUMBER:	376624483
ADMINISTRATOR:	MUHUBO AHMED		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 376-5088
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92111
CAPACITY:	14	CENSUS: 3	DATE:	08/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Muhubo Ahmed		TIME COMPLETED:	02:50 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 8/18/22 at 12:00pm Licensing Program Analyst (LPA) Patrick Ma conducted an unannounced annual inspection with the Licensee. Upon arrival, LPA met with Licensees Muhubo Ahmed. Also, in the home was husband Osman Hanulle, and adult daughters Rahmo Dahir and Salma Dahir with her infant daughter. Licensee was provided the Inspection Checklist (LIC 126). The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present in the home were 3 day care children. Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room, kitchen/dining room, family room, main bathroom and backyard. Off limits areas include garage, two bedrooms, and master bed/bath and are inaccessible through use of door knob covers. The licensee has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. LPA conducted child care quality management interview with the Licensee with the help of daughter Rahmo Dahir translating. The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There is no body of water on the property. Licensee states that there are no weapons in the home. First Aid and CPR certifications expires on 7/2024. Licensee has required immunizations. Licensee is exempt from Mandated Reporter Training as their primary language is Somalia. Children’s and Staff records were reviewed.

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick Ma	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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 08/18/2022 02:29 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: AHMED, MUHUBO FAMILY CHILD CARE	FACILITY NUMBER: 376624483
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on file review, Licensee did not have documents of LIC 995A Parent's rights, LIC 282 Liability Insurance, Immunization Records for 9 out of 12 children enrolled. This poses a potential hazard to the health and safety of children in care if not corrected.
	POC Due Date: 09/18/2022
	Plan of Correction
1 2 3 4	Licensee stated she will have parents complete missing documents and submit proof to LPA Ma via email (patrick.ma@dss.ca.gov) by 9/18/22.

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: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick Ma	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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: AHMED, MUHUBO FAMILY CHILD CARE	FACILITY NUMBER: 376624483
	VISIT DATE: 08/02/2022

NARRATIVE

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Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed the safe sleep regulations with licensee and discussed the Childcare Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed with Licensee the LIC 311D, Forms/Records. To Keep In Your Family Childcare Homes, children’s forms/records, facility forms/records, and information to be posted.

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 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Childcare Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick Ma	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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: AHMED, MUHUBO FAMILY CHILD CARE	FACILITY NUMBER: 376624483
	VISIT DATE: 08/02/2022

NARRATIVE

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LPA discussed and provided Licensee with the following: childcare advocates-email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Childcare Licensing Duty Line at (619) 767-2248.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Childcare 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 Childcare Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

See LIC809D for deficiencies cited.

Exit interview conducted and report was reviewed with the licensee Muhubo Ahmed. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Renesha Askew	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick Ma	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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