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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100144
Report Date: 11/21/2023
Date Signed: 11/21/2023 02:28:35 PM

Document Has Been Signed on 11/21/2023 02:28 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 N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:HASAN, ALI & ABD, AHMED FAMILY CHILD CAREFACILITY NUMBER:
376100144
ADMINISTRATOR:ALI H. & AHMED A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 277-8580
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
11/21/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ali HasanTIME COMPLETED:
02:45 PM
NARRATIVE
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On 11/21/23 at 10:30 am Licensing Program Analyst (LPA) Gerald Poindexter conducted an unannounced three-yearl inspection. Upon arrival, neither licensee was present. The licensee’s wife Fatima Alewei called her husband, Ali Hasan who arrived at approximately 11:15 am, Ali Hasan. Also, in the home was licensee Hasan’s adult daughter Haneen Abd (who translated from Arabic) and adult son Mohammed Abd. Licensee Ahmed Abd joined by phone at approximately 1 pm and provided translation. No day care children were present. Licensee states they typically arrive afterschool from 1-2 pm. The licensee was provided with the Inspection Checklist (LIC 126). The 5-bedroom, 3-bath, two-story home was toured and inspected to ensure an environment safe for the care and supervision of children.

The licensees have provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room #1, Bedrooms #2, and 3, and Bathrooms #1. Off limits areas include all second floor bedrooms, kitchen, laundry room, garage, and backyard, which are inaccessible through use of a safety gate. There are stairs in the home. Stairs are barricaded when children under age 5 years old are present. The facility has sufficient toys and equipment available.

The home has a fully-fenced, backyard area, but it is not used. Instead, licensee uses the nearby middle school playground for outdoor activities. The licensee understands that visual supervision is always required during outdoor activities. In the backyard, there is a pool combined with a jacuzzi. There is a surrounding gate, at least five-feet high with self-latch, and door that swings outward. Neither is in use nor filled with water.

There is a fully charged fire extinguisher, smoke and carbon monoxide detector that meet requirements and are operational. The fireplace located in living room #1 is inaccessible to children. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children via safety gates, doorknob covers, high placement. Adequate heating and ventilation are provided. There is a working telephone and email address. Licensee stated there are NO firearms and weapons in the home.CONTINUED ON PAGE 2

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HASAN, ALI & ABD, AHMED FAMILY CHILD CARE
FACILITY NUMBER: 376100144
VISIT DATE: 11/21/2023
NARRATIVE
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LPA observed all required postings were posted. Children’s records were reviewed and found to be incomplete. Staff records were reviewed. Licensees have the required immunizations per SB792. Licensee’s Pediatric CPR/First Aid are current with an expiration date of 12/2024 (Hasan) and 3/2024 (Ahmed). Preventative health practices course was completed, which includes lead poison prevention training. Licensee Hasan is exempt from Mandated Reporter Training Certificate. His primary language is Arabic. Licensee Abd’s Mandated Reporter Training Certificates per AB1207 is was not on file during inspection and must be renewed ever 2 years.

Emergency drills were not conducted and documented. The last drill was 11/10/22. Licensees do not maintain a current roster of the children. LPA verified that all adults living or working in the home have been fingerprint cleared and associated. LPA reminded Licensee that all unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203. Duty officer number is (619) 767-2248.



The licensees wer reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA conducted child care quality management staff interview with the licensee. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Ali Hasan 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.

CONTINUED ON PAGE 3
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HASAN, ALI & ABD, AHMED FAMILY CHILD CARE
FACILITY NUMBER: 376100144
VISIT DATE: 11/21/2023
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

The licensee Ali Hasan was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

See LIC809D for deficiencies cited.



Exit interview conducted and report was reviewed with the licensees Ali Hasan and Ahmed Abd. During the exit interview, the licensees Ali Hasan and Ahmed Abd, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 11/21/2023 02:28 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 11/21/2023 at 01:31 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: HASAN, ALI & ABD, AHMED FAMILY CHILD CARE
FACILITY NUMBER: 376100144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observations and review of facility records, licensee has not performed or documented a fire drill every 6 months as required. Most recent drill was 11/10/22, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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Llicensees stated they will conduct a fire drill with the children and log the drill no later than 12/5/22. LPA reminded licensee that fire/emergency drill must be conducted and documented every 6 months. The licensee will send a photo of the Emergency Drills form toLPA via email by POC date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee Ahmed Abd did not comply with the section cited above. He did not have a Mandated Reporter certificates on file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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Mr. Abd stated that he will provide the Mandated Reporter Training certificate no later than 12/5/23.
Mandated Reporter online website address is: mandatedreporterca.com
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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 11/21/2023 02:28 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 11/21/2023 at 01:31 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: HASAN, ALI & ABD, AHMED FAMILY CHILD CARE
FACILITY NUMBER: 376100144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, as of 5 of 5 children enrolled did not have documentation available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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Licensee state they will obtain all required signed and dated children's form LIC700 from parents for each enrolled child C1 through C5 by due date of 12/5/2023. Licensees will email documents to LPA Poindexter at Gerald.Poindexter@dss.ca.gov or use another delivery method.
Type B
Section Cited
CCR
102421(c)
Child's Records
(c) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school as required in Section 102416.5(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, as of 5 of 5 children enrolled did not have documentation available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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Licensees state they will obtain all required signed and dated children's forms from parents for each enrolled child C1 through C5 by due date of 12/5/2023. Licensees will email documents to LPA Poindexter at Gerald.Poindexter@dss.ca.gov or use another delivery method.
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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 11/21/2023 02:28 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 11/21/2023 at 01:31 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: HASAN, ALI & ABD, AHMED FAMILY CHILD CARE
FACILITY NUMBER: 376100144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, as of 5 of 5 children enrolled did not have documentation available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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Licensees state they will obtain the required children's form LIC627 from parents for each enrolled child by due date of 12/5/2023. Licensees will email documents to LPA Poindexter at Gerald.Poindexter@dss.ca.gov or use another delivery method.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, as the licensee did not have documentation available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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Licensee state they will download a copyof the childrens roster form LIC9040 and complete, in full, as required by due date of 12/5/2023. LPA has also printed a copy for licensee during the inspection. Licensees will email document to LPA Poindexter at Gerald.Poindexter@dss.ca.gov or use another delivery method.
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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 11/21/2023 02:28 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 11/21/2023 at 01:31 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: HASAN, ALI & ABD, AHMED FAMILY CHILD CARE
FACILITY NUMBER: 376100144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, as 5 of 5 children enrolled did not have documentation available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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Licensee state they will obtain all required signed and dated children's form LIC995A from parents for each enrolled child C1 through C5 by due date of 12/5/2023. Licensees will email documents to LPA Poindexter at Gerald.Poindexter@dss.ca.gov or use another delivery method.

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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 11/21/2023 02:28 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 11/21/2023 at 01:31 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: HASAN, ALI & ABD, AHMED FAMILY CHILD CARE
FACILITY NUMBER: 376100144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, LPA concluded that licensee did not have documentation on file for 5 of 5 children in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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3
4
Licensees state they will obtain all required signed and dated children's form LIC282 from parents for each enrolled child C1 through C5 by due date of 12/5/2023. Licensees will email documents to LPA Poindexter at Gerald.Poindexter@dss.ca.gov or use another delivery method.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


LIC809 (FAS) - (06/04)
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