376629254-2-8-2022-20-CC-JARL-CBFNJN-20220208093036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629254
Report Date: 02/08/2022
Date Signed: 02/08/2022 09:30:45 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:	ALAWAD, MOHAMED FAMILY CHILD CARE		FACILITY NUMBER:	376629254
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	02/08/2022
TYPE OF VISIT:	Office	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Mohamed Alawad		TIME COMPLETED:	09:30 AM

NARRATIVE

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On February 8th, 2022 at 8:30 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi met with Applicant Mohamed Alawad for a scheduled office visit. The purpose of this scheduled appointment was to review together the pending documents listed on the LIC 184B “Notification of Incomplete Application Family Child Care Home Application”. Language Link Operators 12322 and 12324 provided Arabic translation services.

The CCL duty line number is 619-767-2248. The website to obtain licensing regulations and application forms is www.ccld.gov. LPA provided blank copies of the licensing forms missing in the application packet.

LPA advised Licensee of vaccination verification requirements. LPA advised Licensee that according to Health & Safety Section 1597.622 (a)(1)(b)(3) :

“ … a person shall not be employed …. at a family day care home if he or she has not been immunized against influenza … Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year …. A person is exempt from the requirements of this section only under any of the following circumstances: …. The person submits a written declaration that he or she has declined the influenza vaccination. This exemption applies only to the influenza vaccine …”

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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: ALAWAD, MOHAMED FAMILY CHILD CARE	FACILITY NUMBER: 376629254
	VISIT DATE: 02/08/2022

NARRATIVE

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LPA advised Applicant that according to Health & Safety Section 1596.866 (a)(1)(2)(C)(i):

“ … In addition to other required training, at least one director or teacher at each day care center, and each family day care home licensee who provides care, shall have at least 15 hours of health and safety training, and if applicable, at least one additional hour of training pursuant to clause (ii) of subparagraph (C) of paragraph (2). ….. for licenses issued on and after July 1, 2020, instruction in the prevention of lead exposure that is consistent with the most recent State Department of Public Health’s training curriculum on childcare lead poisoning prevention….”

LPA again provided Applicant with a resource list of EMSA instructors who provide the lead exposure prevention training component.

LPA provided the LIC 184B Notification of Incomplete Application form previously provided to Applicant. LPA also provided Applicant with blank copies of the following forms for completion: LIC 508 "Criminal Record Statement Form" , LIC 279B "Current Children in Home", LIC 9217 "Readiness Guide", COVID 19 Self Assessment and FCC Self Certification forms.

Applicant stated he will provide the licensing department the completed above forms, missing documents and training certificate no later than March 8th, 2022. Applicant acknowledges that without receipt of the absent forms and documents, his application may be denied. Applicant acknowledges that should his application be denied, he will be unable to re-apply for a period of one year.

Applicant acknowledged licensed daycare shall not be done at the application address until it has been licensed. LPA advised Applicant that if childcare is conducted at unlicensed addresses, the residents are subject to a civil penalty of $200 per day. Applicant acknowledged that should daycare be conducted at the application address prior to licensure, then the unlicensed operator may be fined and/or this application denied.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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: ALAWAD, MOHAMED FAMILY CHILD CARE	FACILITY NUMBER: 376629254
	VISIT DATE: 02/08/2022

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 26 27 28 29 30 31 32	An exit interview was conducted with Applicant Mohamed Alawad. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to Applicant Mohamed Alawad and their signature on this form confirms receipt of these rights.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC809 (FAS) - (06/04)

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