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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629255
Report Date: 03/10/2022
Date Signed: 03/10/2022 11:30:14 AM


Document Has Been Signed on 03/10/2022 11:30 AM - 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:KHAMIS, MARIAM FAMILY CHILD CAREFACILITY NUMBER:
376629255
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
03/10/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Mariam Khamis, LicenseeTIME COMPLETED:
11:50 AM
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On 03/10/2022 at 10:50 pm, Licensing Program Analyst (LPA), Michelle Hood conducted an unannounced case management inspection with the licensee, Mariam Khamis. LPA notified the licensee the purpose of the inspection was for a change of capacity and the licensee led LPA on a tour of the facility. There were no daycare children at the facility during the time of the inspection; however, the licensees minor child was present.
On 03/08/2022, a fire clearance was approved for 14 children. Licensee will use the following areas for child care: living room, kitchen, dining room, backyard, bedroom #2 and bathroom #1. The off-limits area is made inaccessible via doorknob covers. There are no bodies of water observed during the time of inspection. There is a sufficient amount of age-appropriate toys, games, and books available. The home was clean and orderly during the inspection. The fire extinguisher is rated 2-A;10; BC, smoke alarm, and carbon monoxide detector are operational. The is a working telephone in the home and all required forms are posted. The licensee stated that there are NO firearms or ammunition on the property. The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Any minor upon his/her 18th birthday must be fingerprinted within 30 days. LPA reviewed children's files. The licensee provided LPA a copy of the facility roster. The last fire/disaster drill was conducted 01/14/2022. Pediatric CPR and First Aid certification expire 01/2024. Licensee's mandated reporter training certificate expires on 11/30/2023. LPA discussed with Licensee maintaining supervision of day children at all times. LPA reviewed the following with the licensee: SIDS, car seat law, reporting requirements, shaken baby syndrome, and care and supervision. Licensee was also reminded the following items are prohibited during daycare operating hours (walkers, exersaucers, jumpers, and bouncy seats). Corporal punishment and smoking are not allowed in the daycare.

LPA and licensee discussed the safe sleep regulations and discussed the Child Care Licensing Safe Sleep webpage at
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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: KHAMIS, MARIAM FAMILY CHILD CARE
FACILITY NUMBER: 376629255
VISIT DATE: 03/10/2022
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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. The licensee physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age and available for the Department for review. The licensee understands infants up to 12 months of age must be placed on their backs for sleeping.

Incidental Medical Services (IMS) policy was discussed. Licensee does not provide IMS at this time. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.html

The maximum capacity for a large family child care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there are no Qualified Assistants, 14 years of age or present, the capacity reverts back to the requirements for a Small Family Child Care. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

A copy of the licensing report and appeal rights were provided to the licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted with licensee Mariam Khamis.

A Regular Large Family Child Care Home license may be issued for 14 children upon final file review.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC809 (FAS) - (06/04)
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