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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100632
Report Date: 10/04/2022
Date Signed: 10/04/2022 12:19:37 PM

Document Has Been Signed on 10/04/2022 12:19 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: 1DATE:
10/04/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Shawbo JamilTIME COMPLETED:
12:45 PM
NARRATIVE
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On 10/4/22 at 9:18am Licensing Program Analyst, Patrick Ma conducted an unannounced Case Management – Licensee initiated inspection for an increase in capacity from eight (8) to fourteen (14) children. LPA was greeted at the front door by Licensee, Shawbo Jamil. Also present in the home was adult daughter Lava Khurshid. There was on child care child present. Licensee stated daughter Lava Khushid helps her “sometimes” and transports the children to and from school.

On 8/22/22, the licensee submitted an application (LIC 279) to request an increase of capacity. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal and granted the capacity increase to fourteen (14) children on 9/6/2022.

The 3 bedroom, 2 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Licensee will be using the living room, bathroom 1, kitchen, front and backyard for child care. Off limit areas are bedrooms 1-3, bathroom 2, and storage/laundry room and needs to be inaccessible at all times during child care. Licensee was advised to provide visual supervision at all times when children are outdoors.

The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water on the property. Applicant states that there are no weapons in the home. Children’s records were reviewed.
LPA provided 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-and-resources/safe-sleep as an additional resource.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
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 10/04/2022 12:19 PM - It Cannot Be Edited


Created By: Patrick Ma On 10/04/2022 at 11:32 AM
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: JAMIL, SHAWBO FAMILY CHILD CARE
FACILITY NUMBER: 376100632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2022
Section Cited
CCR
102416.1

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102416.1 Personnel records shall be maintained on each employee...
This requirement was not met as evidenced by:
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Licensee stated she will submit proof of all helper documents for Lava Khushid to the department by 11/4/22.
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Based on file review, the licensee did not have any employee records on file for helper/daughter Lava Khushid which poses a potential health and safety risk to 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 Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022


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: JAMIL, SHAWBO FAMILY CHILD CARE
FACILITY NUMBER: 376100632
VISIT DATE: 10/04/2022
NARRATIVE
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Licensee was reminded of the staffing/capacity ratios for Large Family Child Care Homes. Twelve (12) children, no more than 4 infants (birth to 24 months) and 8 older children over the age of 2. A qualified assistant (age 14 or older) is required. For fourteen (14) children, no more than 3 infants (birth to 24 months) and 11 older children; at least 2 school age, 1 child at least age 6, 1 child enrolled in and attending kindergarten or elementary school. Landlord consent and written parent notification are required when caring for more than 12 children. When there isn't a qualified assistant, licensee must follow Small Family Home Child Care Regulations.

Licensee stated she transports children to and from school. Inspection of the Licensee’s car and interview with Licensee showed she only has one child car seat and no booster seat. Licensee stated she believed that a car seat was only needed for children 5 and under. California Car Seat law states children under 8 must be buckled into a car seat or booster in the back seat.

See LIC 809D for Deficiencies cited today.

The following correction is needed.
• Daughter/helper Lava Khurshid was missing a complete staff file, except for her immunizations.

Applicant understands that corrections must be submitted to the Department within 30 days or the application may be denied. Exit interview conducted and report was reviewed with the applicant Shawbo Jamil. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC809 (FAS) - (06/04)
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