376626182-3-3-2021-51-CC-TBLK-BYRUR6-20210303144815

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376626182
Report Date: 03/03/2021
Date Signed: 03/03/2021 02:48:30 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:	SOFI, HUSAM & ISMAEL, INTISAR FAMILY CHILD CARE		FACILITY NUMBER:	376626182
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS:	DATE:	03/03/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:32 PM
MET WITH:	Husam Sofi		TIME COMPLETED:	02:45 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	Licensing Program Analyst (LPA), Tyra Block, conducted an unannounced case management tele-inspection for a capacity increase with the Licensee. The tele-inspection was conducted via MS Teams due to COVID-19 State of Emergency. No children were present only the adult residents. The single story, 3bedroom, 2 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher (2A10BC), carbon monoxide detector, and smoke detector meet requirements and are operational. LPA observed the newly installed fire alarm and pull station. All hazardous items were latched/locked and secured out of reach of children. No bodies of water were observed on the property. Licensee states that 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. First Aid and CPR certifications expire on 4/21. Licensee and all adults living in the home meet immunization requirements. Fire clearance was received on 2/22/21. Applicant understands that landlord consent must be obtained to care for 14 children and Parent Notification of Additional Children in Care must also be on file. Licensee will be using the following rooms for childcare: Living Room, Bedroom #1, Kitchen, and Hall Bathroom. The following areas will be off limits: Backyard, Bedroom #2, Bedroom #3, and Bathroom located in Bedroom #1. The applicant has sufficient toys and equipment available. A nearby park will be used for outdoor activities. Licensee was reminded of the following information: reporting requirements for suspected child abuse and unusual incidents, children’s records, immunizations, adults living or working in the home and related civil penalties, shaken baby syndrome, Safe Sleep Regulation/SIDS, and Effects of Lead. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021

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: SOFI, HUSAM & ISMAEL, INTISAR FAMILY CHILD CARE	FACILITY NUMBER: 376626182
	VISIT DATE: 03/03/2021

NARRATIVE

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LPA observed COVID-19 posters posted, sufficient PPE, hand hygiene, and disinfectants.

No deficiencies are cited. No corrections are needed; a license for 14 will be issued effective today.

Licensee will be provided a copy of this report and Appeal Rights (LIC 9058)by email. Licensee will acknowledge receipt of this report and Appeal Rights by replying to the email within 24 hours.

A Notice of Site Visit was provided by email and must be posted for 30 days

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021

LIC809 (FAS) - (06/04)

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