376100521-10-15-2021-51-CC-JLOT-C7TTH5-20211015144408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100521
Report Date: 10/15/2021
Date Signed: 10/15/2021 02:44:20 PM

Document Has Been Signed on 10/15/2021 02:44 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:	MIKHA, WASAN FAMILY CHILD CARE		FACILITY NUMBER:	376100521
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Licensee, Wasan Mikha		TIME COMPLETED:	01:40 PM

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	Licensing Program Analyst (LPA), Jennifer Lott conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Licensee, Wasan Mikha and granted entry after identifying herself and disclosing the purpose of her visit. The licensee is using the following areas for daycare: Living room #1 & #2, kitchen, downstairs bathroom, front yard with constant supervision, bedroom #1, bedroom #2. Off limit areas include: Garage, backyard, bedrooms #3 & #4, upstairs bathrooms. Business Hours are: 6am-12am Sunday through Saturday. The facility currently has 0 children with 0 infants. Licensee provided a copy of their current roster and is operating within the licensed ratio capacity. At 11:30am LPA/Licensee tested the carbon monoxide detector and smoke detector located in the downstairs hallway. Both devices were functional. LPA did not observe any bodies of water on the premises. Licensee, Mikha advised there are no firearms or ammunition stored on the premises. Fireplaces and open face heaters are screened to prevent access by children. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible to children. Front yard play area is partially fenced but used only with constant supervision. Backyard is currently under construction and not available at this time for outdoor play. The last disaster/fire drill was conducted on 08/30/2021. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials. Children’s records contained emergency contact information. There were no immunization records for 9:9 children in care. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights. Pediatric CPR and First Aid cards are current and will expire on 12/2022. Mandated Child Abuse Reporting was waived as licensee's primary language is Arabic. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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: MIKHA, WASAN FAMILY CHILD CARE	FACILITY NUMBER: 376100521
	VISIT DATE: 10/15/2021

NARRATIVE

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Licensee, Mikha was reminded that all adults 18 and over living or workingi n the home, including employees and volunteers, must obtain 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 up to $500.00 maximum per day / per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee, Mikha and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee, Mikha 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.

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.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

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: MIKHA, WASAN FAMILY CHILD CARE	FACILITY NUMBER: 376100521
	VISIT DATE: 10/15/2021

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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Based on today’s visit, deficiencies were observed and noted on the attached LIC 809D. Exit interview conducted and report was reviewed with licensee, Mikha. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/15/2021 02:44 PM - It Cannot Be Edited

Created By: Jennifer Lott On 10/15/2021 at 01:00 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: MIKHA, WASAN FAMILY CHILD CARE	FACILITY NUMBER: 376100521
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's review of facility records and interview with licensee, the licensee did not comply with the section cited above in 9:9 children's records did not contain immunization records which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/29/2021
	Plan of Correction
1 2 3 4	Licensee states they will complete all immunization records for 9:9 children in care and submit proof to LPA via fax or email by POC date.

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:

Tashima Daniel

LICENSING EVALUATOR NAME:

Jennifer Lott

LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

LIC809 (FAS) - (06/04)

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