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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627006
Report Date: 11/26/2019
Date Signed: 11/26/2019 05:50:37 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:ISMAIL, HIBO AHMAD FAMILY CHILD CAREFACILITY NUMBER:
376627006
ADMINISTRATOR:HIBO AHMAD ISMAILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 729-4906
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:14CENSUS: 5DATE:
11/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Hibo Ahamad Isamail, Licensee TIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Elizabeth Rivera conducted an unannounced inspection with the Licensee. Upon arrival LPA met with her adult sister, Bahjo Abukar who was home with Licensee's 23 month old son. Licensee arrived at the home at 2:10 p.m.. Her assistant Ayan Bashir arrived at 2:30 p.m. and licensee left to pick up 4 day care children. The home was toured and inspected to ensure an environment safe for the care and supervision of children.  The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational.  All hazardous items were latched/locked and secured out of reach of children.  There is a community pool but licensee does not use it while day care children are present. Licensee states that there are no weapons in the home. First Aid and CPR certifications expire on 4/30/2021.  Licensee and helpers meet immunization requirements. They are exempt from Mandated Reporter Training due to having limited English proficiency, their primary language is Somali. Licensee maintains a current roster and is conducting emergency/disaster drills according to regulation. Last drill was conducted on 6/8/19.

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, second room, hallway bathroom, and balcony.  Off limits areas include master bedroom/bathroom and are inaccessible through use of doorknob covers. 

Provider is hereby reminded of the following:  Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; 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.   Licensee was also provided with information regarding SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: ISMAIL, HIBO AHMAD FAMILY CHILD CARE
FACILITY NUMBER: 376627006
VISIT DATE: 11/26/2019
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You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website. Just go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly Updates, click on “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and click “subscribe.”

If no IMS provided:
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.

See LIC809D for Deficiencies cited

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.   LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: ISMAIL, HIBO AHMAD FAMILY CHILD CARE
FACILITY NUMBER: 376627006
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2019
Section Cited

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At the time of acceptance of each child into care, the licensee shall provide the child's parent...a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A...
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This regulation requirement was not met as evidenced by: Based on LPAs observation while reviewing files for Child #1-8, and Child #11-14.
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Type B
12/06/2019
Section Cited

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An emergency information card shall be maintained for each child and shall include the child's full name, ... and the parent's authorization for the licensee or registrant to consent to emergency medical care. This regulation requirement was not met as evidenced by:
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LPA's observation while reviewing files without medical consent forms for child #1-7, #10, #12, and #14.
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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: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ISMAIL, HIBO AHMAD FAMILY CHILD CARE
FACILITY NUMBER: 376627006
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2019
Section Cited

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The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
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This regulation requirement was not met as evidenced by: Based on LPAs observation while reviewing files for Child #5, #6, and #9.
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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: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4