376628434-9-5-2019-20-CC-JARL-BFQNFA-20190905102515

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628434
Report Date: 09/05/2019
Date Signed: 09/05/2019 10:25:20 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:	MOHAMED, LUL FAMILY CHILD CARE		FACILITY NUMBER:	376628434
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	09/05/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lul Mohamed		TIME COMPLETED:	10:21 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 a pre-licensing inspection to ensure compliance with CCR Title 22 Division 12 Chapter 3 – Family Child Care Homes. Applicant Lul Mohamed was advised of the visit’s purpose and granted LPA facility entry. Fardowsa Elmi, the Applicant’s adult daughter, was present and provided translation services. The daycare has three (3) bedrooms and two (2) bathrooms. The home has an open kitchen/dining room/living room area. The daycare is a single-family home. The following rooms are to be used for daycare children: one (1) bedroom, one (1) bathroom, living room, dining room and kitchen area. The off-limit areas are the bedrooms and one (1) bathroom. Applicant Mohamed accompanied the LPA on a tour of the home. Toxins, cleaning supplies and poisons were observed inaccessible to children. An appropriate fire extinguisher was observed. Carbon monoxide/smoke detector was present and operational. The home was observed to be clean and orderly, with heating and ventilation for safety and comfort. The facility posting requirements are present in a common area. The front yard will be used for outdoor activities. The Applicant acknowledges continuous, visual supervision will be used whenever children are engaged in outdoor activities. 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 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. New Senate Bill 792 pertains to immunizations, which requires all adults in daycare operation to have documentation of immunizations for Measles, Pertussis or Whooping Cough and Influenza or Flu. Applicant

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

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: MOHAMED, LUL FAMILY CHILD CARE	FACILITY NUMBER: 376628434
	VISIT DATE: 09/05/2019

NARRATIVE

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Mohamed has provided current verification of required immunizations and facility is in full compliance.

LPA and Applicant discussed California Megan's Law. The website to California’s Megan’s Law website is www.meganslaw.ca.gov. This website address was provided to the Applicant.
LPA provided and discussed with Applicant Mohamed the pre-licensing packet of information. Resource and nutrition programs were discussed. LPA provided the Applicant with the “Heart and Nutrition” newsletter. General health and safety child care standards, capacity and child abuse reporting responsibilities were also reviewed with the Applicant. Continuing operation requirements, record keeping, effects of lead poisoning, and physical home compliance were reviewed by LPA and Applicant. Also discussed were items prohibited in family day care homes. LPA provided and reviewed with Applicant Provider Information Notice (PIN) 19-06-CCP, which states the US Consumer Product Safety Commission has issued a safety recall of specific sleepers due to a number of infant deaths. LPA also provided and discussed with Applicant with PIN 19-02-CCP, which describes the Safe Sleep Awareness campaign. Applicant and LPA discussed safe sleep techniques and Sudden Infant Death syndrome. LPA provided Applicant with information about Shaken Baby syndrome. The Applicant expressed an understanding that physical discipline/corporal punishment shall never be permitted in the child care operation. LPA provided and discussed with Applicant PIN 19-08-CCP, which describes new immunization requirements issued by the Department of Public Health. LPA further provided and discussed with Applicant PIN 19-07-CCP, which provided information regarding radon toxicity and free testing. The Applicant was advised of their responsibility to be current on all regulatory changes by viewing the Community Care Licensing webpage at www.ccld.ca.gov. LPA advised the Applicant of the Child Care Advocate Program.

No corrections are needed. A small license is issued effective today 09/05/2019. The Applicant will physically retrieve the license from the licensing office when available.

An exit interview was conducted with Applicant Mohamed and a copy of this report and Licensee Rights (LIC 9058) were given for facility records.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

LIC809 (FAS) - (06/04)

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