376627231-5-10-2023-20-CC-LGAO-CRQ2EG-20230510171956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627231
Report Date: 05/10/2023
Date Signed: 05/10/2023 05:20:12 PM

Document Has Been Signed on 05/10/2023 05:20 PM - It Cannot Be Edited

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 CARE		FACILITY NUMBER:	376627231
ADMINISTRATOR:	AYAN MOHAMED		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 788-1480
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 0	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Ayan Mohamed		TIME COMPLETED:	05:25 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 May 10, 2023, at 2:45 PM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the licensee, Ayan Mohamed. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. No children were present in the facility during this inspection as Ms. Mohamed advised analyst she is currently only conducting care during the weekends with one family of four children. This facility is a one floor, two bedroom, one bathroom apartment. Licensee accompanied LPA inside the facility during this inspection. The following areas used for child care are: the living room, the dining area, the second bedroom and the bathroom. Off limits areas are the master bedroom which is inaccessible through use of a door knob cover that is installed on its entrance handle and the kitchen which is inaccessible through use of an installed safety gate at its entrance. Licensee has a wall heating unit which she attests is inoperable but understands if it is made operable, she will install a safety gate or other security device that will make it inaccessible to children in care. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. Licensee takes children to a local park for outdoor activities whenever needed. No bodies of water observed on the premises during the inspection. Licensee stated 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. Licensee’s First Aid and CPR certifications expire on April of 2024. Licensee has required immunizations. Licensee does not have a current Mandated Reporter Training certificate. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 04/01/23. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider was unaware of the recent safe sleep regulations and has not been documenting infant in care's daily napping routine. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is not maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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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Document Has Been Signed on 05/10/2023 05:20 PM - It Cannot Be Edited

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: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(B)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reivew and interview, the licensee did not comply with the section cited above as she has not been maintaining an infant napping log for the one infant for whom she is providing care which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 05/15/2023
	Plan of Correction
1 2 3 4	Licensee stated that she was not aware of the safe sleep record requirements for infants. Analyst provided licensee with a copy of the updated infant regulations and a sample safe sleep log duing today's visit. Licensee states she will keep track of all infants' sleep from this point forward beginning this weekend and send analyst a copy of the log kept this weekend 05/13/23-05/14/23 by 05/15/23 to complete the correction.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as she did not have a current mandated reporter training certificate which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 06/12/2023
	Plan of Correction
1 2 3 4	The licensee stated she will complete a Mandated Reporter Training Class at www.mandatedreporterca.org and send analyst a copy of the certificate of completion by 06/12/23 to complete the correction.

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: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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: MOHAMED, AYAN FAMILY CHILD CARE	FACILITY NUMBER: 376627231
	VISIT DATE: 05/10/2023

NARRATIVE

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LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248. Unusual Incident Reports may be e-mailed to: SDIncidentReports@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.

Two type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the licensee, Ayan Mohamed. 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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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