376627136-9-20-2019-20-CC-JARL-BG7NAB-20190920101716

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627136
Report Date: 09/20/2019
Date Signed: 09/20/2019 10:17:23 AM

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:	ALI, FADUMO FAMILY CHILD CARE		FACILITY NUMBER:	376627136
ADMINISTRATOR:	FADUMO ALI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 394-1700
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 3	DATE:	09/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Fadumo Ali		TIME COMPLETED:	10:20 AM

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) Jo Ann Legaspi conducted an unannounced inspection with the Licensee. Kayfa Ahmed, the Licensee’s adult daughter, provided translation services as needed. The home was toured and inspected to ensure a safe environment for the care and supervision of children. The daycare has four (4) bedrooms and two (2) bathrooms; it is a single-family home. Present in the home was the Licensee, the Licensee’s two (2) adult daughters and three (3) related children. The fire extinguisher, carbon monoxide and smoke detector satisfy requirements and are operational. The last safety drill was on 06/29/2019. Hazardous items were secured inaccessible to children. There are no bodies of water in the home. There are no weapons in the home, per the Licensee. A review of staff records indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aide and CPR certifications expire in March 2020. Reviewed children records were observed to be complete. Licensee has provided adequate space for the children to eat, sleep and play within the home. The living room, two (2) bedrooms, and one (1) bathroom are used for child care. The Licensee has sufficient toys and available equipment. All equipment that is used should be used only as intended by the manufacturer. Outdoor activities are conducted at a nearby park. The Licensee acknowledged continuous, visual supervision is to be given to children whenever engaged in outdoor activities. The provider was 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. The 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

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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: ALI, FADUMO FAMILY CHILD CARE	FACILITY NUMBER: 376627136
	VISIT DATE: 09/20/2019

NARRATIVE

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provided, a “Plan for Providing IMS” must be submitted to Community Care Licensing. 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 provided the Licensee with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days.

Based on today's visit, no deficiencies were observed. An exit interview was conducted with the Licensee, who was provided a copy of their Licensee Rights (LIC 9058 1/16). Their signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

LIC809 (FAS) - (06/04)

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