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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625544
Report Date: 02/06/2023
Date Signed: 02/06/2023 04:42:49 PM


Document Has Been Signed on 02/06/2023 04:42 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:FALLAH, HAWA FAMILY CHILD CAREFACILITY NUMBER:
376625544
ADMINISTRATOR:HAWA FALLAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 366-4248
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 0DATE:
02/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Hawa FallahTIME COMPLETED:
12:15 PM
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On 2/06/2023, at 9:30am, Licensing Program Analyst (LPA), Cindy Meier and conducted an unannounced Annual Inspection and met with Licensee, Hawa Fallah. LPA disclosed the purpose of the inspection and was led on a tour of the facility indoors and outdoors. This facility is a one story, three-bedroom, two-bathroom house with a detached bedroom and outside bathroom. The following areas are used for childcare: living room, dining room, kitchen and bathroom #1. Off limits areas include: detached bedroom, outside bathroom, bedroom #1, #2, #3, bathroom #2 and are made inaccessible through the use of doorknob covers.
Hours of operation hours are Monday – Saturday 12:00am to 11:50pm. There were no children present during the inspection.

The fire extinguisher and smoke detector met requirements. The facility does not have a working carbon monoxide detector. Hazardous items were inaccessible to children in care. LPA informed licensee poisons shall be placed in a storage area and locked. LPA did not observe any poisons during the inspection. The storage area for poisons is locked. LPA observed toys and materials available for children’s use. The home has a fenced front and side yard available for outdoor activities. The back yard is off limits for children to use. LPA informed licensee to ensure children are supervised at all times during outdoor activities. There is no fireplace on the premises. Licensee stated there are no bodies of water and LPA did not observe any bodies of water during the inspection. Licensee stated there are no firearms, other weapons or ammunition in the home.

A review of staff records on this date indicates that the resident who lives in the detached bedroom does not have a criminal record clearance. See LIC 809-D.

LPA reviewed children’s files. Children’s files reviewed were complete and met regulations.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy MeierTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
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: FALLAH, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376625544
VISIT DATE: 02/06/2023
NARRATIVE
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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 Child Care 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.

Licensee has been exempt from taking the Mandated Reporter training course. Licensee has obtained a Basic Life Support certification in CPR and First Aid. LPA discussed that this is not an EMSA approved course and licensee agreed to take the EMSA CPR & First Aid course. Technical Assistance provided. Property Owner/Landlord Consent form LIC9149 is on file, signed by landlord and approves licensee to care for fourteen (14) children. Licensee has required immunizations, per file review. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted in 2020. Required documents are posted.

Incidental Medical Services (IMS) policy were discussed. 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.

LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage 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.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy MeierTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
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: FALLAH, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376625544
VISIT DATE: 02/06/2023
NARRATIVE
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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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

Per California Code of Regulations, (Title 22, division 12 & Chapter 3) one (1) Type A citations, two (2) Type B citations are being cited on the attached LIC 809-D.

LPA Cindy Meier informed Licensee, Hawa Fallah that this report dated 2/6/23 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy MeierTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
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: FALLAH, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376625544
VISIT DATE: 02/06/2023
NARRATIVE
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Also, LPA Cindy Meier informed the Licensee, Hawa Fallah to provide a copy of this licensing report dated 2/6/23 that documents Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with licensee, Hawa Fallah. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy MeierTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/06/2023 04:42 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: FALLAH, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376625544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in that (1) out of (1) persons working/residing in the home did not have a criminal record background clearance which poses an immediate health, safety or personal rights risk to persons in care.
Resident who lives in detached bedroom is not cleared.
POC Due Date: 02/06/2023
Plan of Correction
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Licensee will ensure resident, Mamadou Diallo will obtain a criminal record clearance via Livescan by 2/6/23 and prior to returning to the facility. Licensee will send proof to CCLD.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy MeierTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 02/06/2023 04:42 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: FALLAH, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376625544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst observation, the licensee did not comply with the section cited above in that she doe not have a carbon monoxide detector in the home which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 02/10/2023
Plan of Correction
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Licensee states she will purchase a carbon monoxide detector, install it and send analyst a photo of the purchase receipt by 02/10/23 to complete the correction.
Type B
Section Cited
CCR
102417(g)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that there are bees entering the outside of the house on the far yard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/24/2023
Plan of Correction
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Licensee stated she will ensure children do not play in the section of the yard where the bees are entering until they are exterminated. Licensee will send CCLD proof of 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 GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy MeierTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 02/06/2023 04:42 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: FALLAH, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376625544

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(6)
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: (6) Outdoor play areas shall be either fenced, or outdoor play areas shall be supervised by the licensee Section 102417(g)(5).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on oberservation and interview both the left and right side gates are non operational and allow children access to the off limits backyard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
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Licensee stated she will ensure the children do not have access to the back yard, will have the gates repaired and installed so children do not have access to the backyard. Licensee will take photos of the gates and send to CCLD by 3/3/23.
Section Cited
Personnel Requirements
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy MeierTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
LIC809 (FAS) - (06/04)
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