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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100057
Report Date: 10/31/2024
Date Signed: 12/06/2024 01:25:50 PM

Document Has Been Signed on 12/06/2024 01:25 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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:DIOP, KOUMBA FAMILY CHILD CAREFACILITY NUMBER:
376100057
ADMINISTRATOR/
DIRECTOR:		KOUMBA DIOPFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 583-3850
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 20CENSUS: 3DATE:
10/31/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:49 PM
MET WITH:Koumba DiopTIME VISIT/
INSPECTION COMPLETED:
06:36 PM
NARRATIVE
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This is an amended report delivered on December 6, 2024.

On October 31, 2024 @ 5:49 PM., Licensing Program Analyst (LPA) Sherlynn Banas conducted a case management inspection. During the inspection, LPA Banas was checking the records of staff and learned that Staff #1 had been working at the facility without a completed fingerprint clearance.

Type A deficiency is being cited on the attached LIC 809D. A civil penalty of $500 will be assessed on the attached form 421BG.

LPA, Sherlynn Banas informed Licensee, Koumba Diop that this report dated 10/31/2024 shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA, Sherlynn Banas informed the licensee, to provide a copy of this licensing report dated 10/31/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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Document Has Been Signed on 10/31/2024 06:21 PM - It Cannot Be Edited


Created By: Sherlynn Banas On 10/31/2024 at 05:57 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: 10/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2024
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance. All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility:Obtain a California clearance or a criminal record exemption as required by the Department.
This requirement was not met as
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Licensee, Koumba Diop stated that she will follow up with the completion of the fingerprint clearance. She will place Staff #1 on leave while waiting for the clearance to be completed. Staff #1 will return when clearance is completed.
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Based on record review, Staff #1 was hired and allowed to work before the background clearance was completed. This is an immediate risk to the health and safety of the 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:Tashima Daniel
LICENSING EVALUATOR NAME:Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2024


LIC809 (FAS) - (06/04)
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