<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100632
Report Date: 08/10/2021
Date Signed: 08/10/2021 12:14:10 PM

Document Has Been Signed on 08/10/2021 12:14 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:JAMIL, SHAWBO FAMILY CHILD CAREFACILITY NUMBER:
376100632
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
08/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Shawbo Jamil TIME COMPLETED:
12:20 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
On 08-08-21 at 10:00 AM, Licensing Program Analyst’s (LPA’s) LeAndra Dolliole and Joelle Redding, conducted an announced Change of Location inspection. LPA’s met with applicant Shawbo Jamil. The one story, 3 bedroom, 2 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children.

The fire extinguisher located under the kitchen sink, carbon monoxide detector located in the kitchen and smoke detector located in the kitchen and hallway meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children.

Applicant states that there are no weapons, ammunition or bodies of water in the home or on the property. Applicant states that they have sufficient financial resources to sustain the license. 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. Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Applicant owns the home and has provided proof of control of property.

First Aid and CPR expire in March 2023 and preventative health practices course were completed in May 2021. Lead Poisoning Prevention Training was completed in May 2021. The Mandated Reporter Training was completed in March 2021. Staff immunization requirements were met.The applicant has toys and equipment available. Required documents have been posted. Applicant will be using the following rooms for childcare: Living Room, Bathroom 1 and Kitchen.
Report cont. on ....809C
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Leandra Dolliole
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: JAMIL, SHAWBO FAMILY CHILD CARE
FACILITY NUMBER: 376100632
VISIT DATE: 08/10/2021
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
26
27
28
29
30
31
32
The following areas will be off limits: Bedrooms 1, 2 and 3, Bathroom 2, and storage/laundry room. Off-limits are inaccessible by use of doorknob cover and locks. Applicant stated they will be using the front yard and backyard patio for outdoor play. Applicant will provide visual supervision during outdoor play at all times.

The new provider packet was reviewed with the applicant including information on child abuse reporting, children’s records, immunizations, adults living or working in the home, ratios, capacity and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed Shaken Baby Syndrome and California Megan's Law and LPA provided: www.meganslaw.ca.gov. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress. Applicant was provided COVID-19 resources and directed to website: www.ccld.ca.gov to receive important updates and information.

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.
LPA discussed and provided applicant with the following information:
· Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov.
· For common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

Applicant agreed to comply with all regulations and laws governing family child-care homes. Upon final file review, the change of location will be granted and an updated license for 8 children will be sent.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Leandra Dolliole
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2