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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627231
Report Date: 08/15/2019
Date Signed: 08/15/2019 04:31:49 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:MOHAMED, AYAN FAMILY CHILD CAREFACILITY NUMBER:
376627231
ADMINISTRATOR:AYAN MOHAMEDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 788-1480
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:14CENSUS: 1DATE:
08/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Ayan MohamedTIME COMPLETED:
04:35 PM
NARRATIVE
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LPAs, Luigi Gargaro and Martha Malane, conducted an unannounced inspection with the licensee. The home was toured and inspected to ensure an environment safe for the care and supervision of children per the standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present were the licensee and her infant son with no day care children. The fire extinguisher and smoke and carbon monoxide detectors meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. The licensee was asked whether she had any bodies of water or weapons in the home and she replied no. A review of staff records on this date indicates that all adults or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee did not have current First Aid and CPR certifications available for review. Children’s records were reviewed and were found to be in order.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include the living room, the dining area, the second bedroom and the bathroom. Off limits areas include the master bedroom which is inaccessible through use of a door lock and the kitchen which is inaccessible through use of an installed safety gate at the kitchen entrance. The licensee has sufficient toys and equipment available. Licensee takes children to a local park for outdoor activities.

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. LPA and licensee discussed California Megan's Law and he provided licensee with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis.

The licensee was cited for two type B violations during today's visit (see related 809D citations page). Analyst printed a copy of the Notice Of Site Visit today and had licensee place it in her facility notice area before he left the home.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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 2
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: MOHAMED, AYAN FAMILY CHILD CARE
FACILITY NUMBER: 376627231
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2019
Section Cited
CCR
102418(g)
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Immunizations. 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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Licensee states she will contact the parent and obtain the children in question's records, transfer them to the blue immunization cards and submit copies of them to analyst by, 08/26/19
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This requirement was not met when licensee did not have immunizations on file for children #1 and #2. Not having immunization records on file for children upon request is a potential risk to their health and safety.
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Type B
09/16/2019
Section Cited
CCR
102416(c)
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Personnel Requirements. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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Licensee states she will enroll in a CPR/First Aid training class and will submit copies of the completed certifications to analyst by 09/16/19.
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This requirement was not met when licensee did not have current CPR / First Aid certifications on file. Not having current certifications is a potential risk to children in care.
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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: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2