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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100793
Report Date: 03/01/2024
Date Signed: 03/01/2024 11:46:11 AM

Document Has Been Signed on 03/01/2024 11:46 AM - 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, CEZAR FAMILY CHILD CAREFACILITY NUMBER:
376100793
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
03/01/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Cezar YaqoobTIME COMPLETED:
12:00 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 3/1/24 at 8:30am Licensing Program Analyst (LPA) Patrick Ma conducted an unannounced inspection for an increase in capacity application. Licensee submitted application to the Department on 12/12/23. Fire clearance was completed on 1/8/24. Also, in the home was Licensee’s mother and helper, Suaad Korkees. The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. There were no children in care initially, at 10:05am 2 children arrived during inspection.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room 1, dining room, master bedroom and bath. Off limits areas include garage, living room 2, kitchen, bedroom 1 & 2, and hallway bathroom and are inaccessible through use of door knob covers and latches, however, living room and kitchen’s double doors need to be made inaccessible to children. Licensee showed 5 stuffed animals as equipment and toys available to children. The home has a fenced backyard available for outdoor activities. Pool in the backyard was properly fenced. Upon arrival, pool gate was shut and latched but during inspection LPA discovered self-latching gate was not working and remains open after unlatching, which will need to be corrected.

The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee states that there are no weapons in the home. First Aid and CPR certifications expire on 1/11/25. Preventative Health training was completed on 8/21/16 and Lead Prevention training was completed 6/30/21. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 8/15/23 and is reminded it must be completed every 2 years. Children’s and Staff records were reviewed.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
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 5
Document Has Been Signed on 03/01/2024 11:46 AM - It Cannot Be Edited


Created By: Patrick Ma On 03/01/2024 at 10:50 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: YAQOOB, CEZAR FAMILY CHILD CARE
FACILITY NUMBER: 376100793

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2024
Section Cited
CCR
102417(5)(A)

1
2
3
4
5
6
7
102417(5)(A) Operation of a Family Child Care Home. All licensees shall ensure the inaccessibility of pools… gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated he will provide prooof to the Department pool gate is fixed and self-latching by 3/4/24 and not permit children use of the backyard until gate is fixed and inspection by the Department.
8
9
10
11
12
13
14
Based on observation, pool self-latching gate did not self latch and remained open which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
03/04/2024
Section Cited
HSC1597.622(a)(1)

1
2
3
4
5
6
7
§1597.622 (a) (1)a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. This requirement was not met as evidenced by:

1
2
3
4
5
6
7
Licensee stated he will have helper documents on file at home by 3/4/24, available for inspection.
8
9
10
11
12
13
14
Based on records review and interview, there were no required helper documents on file for his mother/helper. Licensee stated his mother helps him with child care and was observed by LPA, but was unaware she required helper documents onf file which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
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: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 03/01/2024 11:46 AM - It Cannot Be Edited


Created By: Patrick Ma On 03/01/2024 at 11:13 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: YAQOOB, CEZAR FAMILY CHILD CARE
FACILITY NUMBER: 376100793

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2024
Section Cited
CCR
101160(a)

1
2
3
4
5
6
7
101160(a) The license shall be posted in a prominent, publicly accessible location in the center. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee posted license during visit. Deficiency corrected.
8
9
10
11
12
13
14
Based on observatrion and interview, license was not post in the home which poses/posed a potential health, safety or personal rights risk to persons in care. Licensee stated he was told by another analyst that it was not required to be posted
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
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, CEZAR FAMILY CHILD CARE
FACILITY NUMBER: 376100793
VISIT DATE: 03/01/2024
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
Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer.

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

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). If capacity increase is approved, they can operate with a maximum capacity of 14 children.

Capacity limitations were reviewed. Licensee is to be present in the home to ensure children are supervised and is reminded that the license is NOT transferable and should he relocate, this license will be null and void.

Licensee was reminded that annual fees are due on the date they were licensee every year.

See LIC809D for deficiencies cited.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
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, CEZAR FAMILY CHILD CARE
FACILITY NUMBER: 376100793
VISIT DATE: 03/01/2024
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 corrections are needed:

• Pool gate needs to be self-latching
• Double doors to living 2 need to be made inaccessible during child care
• Completed helper file for Suaad Korkees

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 Cezar Yaqoob. 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: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5