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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628434
Report Date: 06/19/2023
Date Signed: 06/19/2023 08:39:59 PM

Document Has Been Signed on 06/19/2023 08:39 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, LUL & ELMI, MARYAMO FAMILY CHILD CAREFACILITY NUMBER:
376628434
ADMINISTRATOR:LUL MOHAMED & MARYAMO ELMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 908-0838
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 0DATE:
06/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lul Mohamed & Maryamo ElmiTIME COMPLETED:
03:05 PM
NARRATIVE
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On June 19, 2023, at 12:30PM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the co-licensees, Lul Mohamed and Maryamo Elmi. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensees. Only the co-licensees and no day care children were present in the facility during this inspection. This facility is a one floor, three bedroom, two bathroom house. Licensees accompanied LPA inside and out of the facility during this inspection.

The following areas used for child care are: the kitchen, the dining area, the living room and the day care bathroom. Off limits areas are the three home bedrooms and the inclusive master bath and are inaccessible through use of locking door knobs on the respective bedroom entrance doors. Licensees understand that during day care hours the off limits room must always be closed and locked to prevent children from accessing them.

The fire extinguisher and combination smoke and carbon monoxide detector met requirements. Most hazardous items were inaccessible to children. The licensees have toys, play equipment and materials available. The home has a fenced backyard that the licensees do not use for day care as it has terraced planters and is a concrete yard. The yard is made of limits with a sliding screen door and locking back door. The licensees instead use the front yard for outdoor activities but as it is open and is on the same property as a second, separately addressed rental home and leads into the not for use back yard, they understand that direct supervision must be provided at all times the children are playing the.

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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
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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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, LUL & ELMI, MARYAMO FAMILY CHILD CARE
FACILITY NUMBER: 376628434
VISIT DATE: 06/19/2023
NARRATIVE
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Licensee Mohamed's First Aid and CPR certifications expire on May of 2025. Licensees have the required immunizations. Licensee Mohamed completed Mandated Reporter Training on 08/28/22. The licensees did not have a facility rosterThe last fire and disaster drills were conducted and documented within the required six month time period. Licensee currently has no infants in care but analyst provided her with a copy of the safe sleep regulations for her to review at a future date.

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.

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

An exit interview was conducted with the licensee. The licensees were 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/19/2023 08:39 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 06/19/2023 at 02:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MOHAMED, LUL & ELMI, MARYAMO FAMILY CHILD CARE
FACILITY NUMBER: 376628434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst observation, the licensee did not comply with the section cited above as unlatched cabinets in bathroom had accessible personal items such as hair care products, razors etc. which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/19/2023
Plan of Correction
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Licensee moved products before analyst left the facility but will install a safety latch for main cabinet where all items will be kept in the future. Analyst will conduct a return inspection visit to ensure that all chemical and personal care products are inaccessible to children in care.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensees did not comply with the section cited above as several of the emergency information cards, though partially filled out, were incomplete including missing contact information which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/26/2023
Plan of Correction
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Licensee stated she will have parents reveiw and complete all paperwork. Analyst will review files during an unannounced return plan of correction visit.
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
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/19/2023 08:39 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 06/19/2023 at 02:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MOHAMED, LUL & ELMI, MARYAMO FAMILY CHILD CARE
FACILITY NUMBER: 376628434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensees did not comply with the section cited above as they did not have a facility roster on file which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 06/19/2023
Plan of Correction
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Licensee stated she will fill out the facility roster for analyst to review during an unannounced return plan of correction visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023


LIC809 (FAS) - (06/04)
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