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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100057
Report Date: 09/27/2021
Date Signed: 09/27/2021 04:53:02 PM

Document Has Been Signed on 09/27/2021 04:53 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:DIOP, KOUMBA FAMILY CHILD CAREFACILITY NUMBER:
376100057
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Koumba DiopTIME COMPLETED:
05:15 PM
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On 9/27/21 at 1:35pm Licensing Program Analysts (LPA) Patrick Ma and Samantha Clenista conducted an unannounced annual inspection with the Licensee. Upon arrival, LPAs met with Licensee Koumba Diop. The two story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present were the Licensee, Helper Aida Manga, and 8 day care children (2 school-aged, 2 infants). Facility was observed operating in ratio.

The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. There is no body of water on the property. Licensee states that 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. First Aid and CPR certifications expired on 6/2021 for Licensee and 7/2021 for Helper Aida. Licensee has required immunizations. Licensee Mandated Reporter Training expired on 8/12/21 and Helper Aida on 8/13/21. Children’s and Staff records were reviewed and found to be in order.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room, bedroom 1 & 2, bathroom, dining room, and playroom. Off limits areas include entire upstairs, bedroom 3 & 4, kitchen, garage and are inaccessible through use of a gate leading upstairs and door knob cover for the bedrooms and garage. The licensee has sufficient toys and equipment available. The home has a fenced backyard but is off limit. Licensee would like to make the backyard available to child care but an air conditioning unit and other equipment that pose possible harm to children must be made inaccessible prior to CCL approval for outdoor activities. There is a nearby school that Licensee takes the children for outdoor activities. Licensee understands that supervision is required at all times during outdoor activities.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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: DIOP, KOUMBA FAMILY CHILD CARE
FACILITY NUMBER: 376100057
VISIT DATE: 09/27/2021
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Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA discussed information regarding SIDS, Lead exposure and Shaken Baby Syndrome. LPAs provided technical assistance regarding the Infant Sleep Plan and Safe Sleep Log documents. Copies of these forms were provided to Licensee. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Ma directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information regarding COVID-19 guidelines.

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.

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.

See LIC809D for deficiencies cited.

Upon Receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with the licensee. 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. Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/27/2021 04:53 PM - It Cannot Be Edited


Created By: Patrick Ma On 09/27/2021 at 03:44 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: DIOP, KOUMBA FAMILY CHILD CARE
FACILITY NUMBER: 376100057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2021
Section Cited
CCR
102417(g)

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Operation of a Family Childcare Home Section 102417(g):..detergents, cleaning compounds, and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by:
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During inspection, Licensee placed a door knob cover on bedroom 4 and stated the room will remain off limits where lotion was available. Paint in the hallway was place in the garage and the latch underneath the sink was locked in the bathroom.
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Paint was accessible in the hallway, ointments and lotion were accessible in bedroom 4, chemicals were located and accessible under the sink in the bathroom because the latch was not locked. This poses an immediate health and safety risk for children in care.
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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:Renesha Pack
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2021


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/27/2021 04:53 PM - It Cannot Be Edited


Created By: Patrick Ma On 09/27/2021 at 04:04 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: DIOP, KOUMBA FAMILY CHILD CARE
FACILITY NUMBER: 376100057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2021
Section Cited
CCR
102425(b)

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102425(b): Safe Sleep Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidenced by:
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Licensee removed blankets and bumper pads from all three cribs while LPAs were present. Licensee stated that she will follow safe sleep regulations and ensure that no items other than tight fitting crib sheet and pacifies are in cribs when infants are present.
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LPA obsered blankets and bumper pads were in four of six cribs/play pens. 3 contained sleeping infants. This poses a potential health and safety risk to persons in care.
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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:Renesha Pack
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2021


LIC809 (FAS) - (06/04)
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