376626049-3-12-2020-20-CC-CGUY-BMMQLS-20200312121623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376626049
Report Date: 03/12/2020
Date Signed: 03/12/2020 12:16:42 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:	SHIRE, HAWEYA FAMILY CHILD CARE		FACILITY NUMBER:	376626049
ADMINISTRATOR:	HAWEYA SHIRE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 581-4118
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 3	DATE:	03/12/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Haweya Shire		TIME COMPLETED:	12:20 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 3/12/20 at 9:32AM Licensing Program Analysts (LPAs), Casey Gulley and Rajani Goudreau conducted unannounced inspection. Upon arrival, LPA met with Licensee Haweya Shire, and proceeded to tour the facility. There were three children in care including one infant, one preschool aged child and one school aged child, along with licensee’s mother. Based on review, there is currently 10 children currently enrolled in the day care. The facility is within ratio and capacity limitations. Child care operation hours are Monday through Friday from 7am to 10 pm. LPA conducted a tour of the home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Licensee has provided adequate space for the children to eat, sleep and play within the home. The home is kept is clean and orderly, with heating and ventilation for safety and comfort. Areas used for child care include: Living room, dining room, downstairs bathroom and kitchen. Off limits areas of the home include: patio, one bedrooms located on first story of home and two bedrooms and two bathroom located on second story of home. LPA informed licensee to ensure off limit areas of the home are made securely inaccessible. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. Children’s toys and play equipment are safe and age appropriate. Primary telephone is a cell which is operational. There are no firearms or other weapons in the home, per licensee. Licensee has all appropriate forms posted, per observation. Fire place located in living room is securely barricaded. Two stair wells are made securely inaccessible by secure gates. There is community pool located in the apartment complex. Pool fencing meets requirements. Licensee utilizes local parks for outdoor play. LPA advised Licensee to provide direct supervision during outdoor activities. Facility roster reviewed and complete. LPA reviewed 10 children's files and six children's files were missing. LPA informed licensee the importance of ensuring children's records are on file and complete. Licensee indicated children started the day care 02/02/20. In addition, two non-school aged children's, See LIC809-C continuation page...

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey Gulley	TELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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: SHIRE, HAWEYA FAMILY CHILD CARE	FACILITY NUMBER: 376626049
	VISIT DATE: 03/12/2020

NARRATIVE

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immunization's were not on file. LPA Pediatric CPR and First-Aid expires in 2/2022. There are no new adults living or working in the home. All adult residents and assistants have criminal record clearance/exemptions and child abuse index clearances. Licensee has met immunization requirement per SB792. In addition, Licensee has not completed the AB1207 Mandated Reporter Training due to applicant having limited English proficiency, applicant’s primary language is Somali.

LPA discussed the following with licensee: California Megan's Law, www.meganslaw.ca.gov. LPA informed licensee in order to access Child Care Licensing Regulations and Forms to visit the following website: http://ccld.ca.gov. LPA discussed the following with licensee: Child Care Advocates, (916) 654-1541, childcareadvocatesprogram@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.

Large: LPA discussed the following with Licensee: Max capacity when there is an assistant present: 12 children-no more than 4 infants (birth to 24 months). When caring for 14 children no more than 3 infants. 1 child in kindergarten and 1 child at least 6 years old. When there is no qualified assistant the capacity reverts back to the requirements from a small child care. You must notify the parents of the children in care when caring for more than 12 children.

LPA discussed the following with Licensee: reporting suspected child abuse & neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in home have criminal background clearances to avoid civil penalties, emergency drills conducted every 6 months and document drills including date/time and type of drill, heat-related illness, child passenger law, unusual incidents and time frames, information on SIDS, shaken baby syndrome, lead poisoning effects brochure. LPA informed licensee corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day care operation.
See LIC809-C continuation page...

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey Gulley	TELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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: SHIRE, HAWEYA FAMILY CHILD CARE	FACILITY NUMBER: 376626049
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/12/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/20/2020 Section Cited	1 2 3 4 5 6 7	102418-Immunizations.(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on file review, licensee did not obtain a copy of two children's immunization records, which poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14
Type B 03/20/2020 Section Cited	1 2 3 4 5 6 7	102421-Child's Records.(b)-The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7). This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on record review, licensee did not have six children’s emergency information card on file including all the required licensing forms, which poses a potential health and safety risk to children in care.	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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey Gulley	TELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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: SHIRE, HAWEYA FAMILY CHILD CARE	FACILITY NUMBER: 376626049
	VISIT DATE: 03/12/2020

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LPA discussed with licensee Community Care Licensing Duty Line: (619) 767-2248, open Monday through Friday from 8:00 a.m. to 5:00 p.m. LPA, Casey Gulley can be reached at (619) 767-2216 and at Casey.Gulley@dss.ca.gov.

Facility was cited two type B deficiencies during today's visit. LPA conducted an exit interview with licensee. LPA discussed and provided the following to licensee: LIC809, LIC809-C, LIC809-D, LIC9213-Notice of Site Visit and appeal rights. LPA informed licensee Notice of Site Visit must be posted for 30 days from today's date. LPA observed licensee post notice of site visit prior to exiting facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey Gulley	TELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

LIC809 (FAS) - (06/04)

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