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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100646
Report Date: 06/21/2021
Date Signed: 07/15/2021 03:19:05 PM

Document Has Been Signed on 07/15/2021 03:19 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:YAQOOB, LUBNA FAMILY CHILD CAREFACILITY NUMBER:
376100646
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/21/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lubna YaqoobTIME COMPLETED:
12:00 PM
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On 6/21/21 Licensing Program Analyst Michael Morales-DeSilvestore conducted an announced Pre-Licensing inspection for relocation with the applicant. The 1 story home was toured and inspected to ensure an environment safe for the care and supervision of children. 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 is a fenced pool in the back yard. The fencing meets all requirements. Applicant states that there are no weapons in the home. CPR and First Aid expire on June 2021. Applicant has signed up for renewal course on 7/18/21. 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. Staff immunization requirements were met. Applicant owns the home.

Applicant will be using the following rooms for childcare: Kitchen, Living room, 3rd bedroom and 1st bathroom. Off limits areas include: 2nd bathroom, 1st and 2nd bedroom and backyard. Off limits areas are inaccessible through the use of door knob covers and gates. The garage will also be off limits and is kept inaccessible through the use of a door knob cover. The home has a fenced front yard available for outdoor activities.

LPA observed the home to be very sparsely furnished. In the kitchen there was no stove and nothing in any of the drawers. There was a commercial freezer like you would see in a super market. There was also a soda fridge with a glass door like in a gas station. The back living room was entirely empty with no furniture. The front living room had 2 couches, one against each wall. The bedrooms had beds with no other furniture. There was limited clothing in the closets. The hall way bathroom was entirely empty with nothing in the cabinets our shower. When the LPA asked the licensee when she moved in, she said 2 days ago. When LPA asked her about her three children that lived in the home, she said they were away playing with a relative. LPA did not see any children's toys/Equipment or tvs.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2021
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: YAQOOB, LUBNA FAMILY CHILD CARE
FACILITY NUMBER: 376100646
VISIT DATE: 06/21/2021
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Applicant was reminded of requirements for children’s records, child abuse, and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA provided information regarding Safe Sleep Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

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.


The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. LPA provided notice of site visit and observed it being posted at the facility.

No corrections are needed. A license for 8 children will be issued following final review.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
LIC809 (FAS) - (06/04)
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