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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100800
Report Date: 10/13/2021
Date Signed: 10/13/2021 04:19:45 PM

Document Has Been Signed on 10/13/2021 04:19 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:KHAMMI, GHADA FAMILY CHILD CAREFACILITY NUMBER:
376100800
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/13/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Applicant, Ghada Khammi TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Jennifer Lott, conducted an announced Pre-Licensing Inspection. LPA was greeted at the front door by Applicant, Ghada Khammi and granted entry after identifying herself and disclosing the purpose of her visit. Lily Habaa provided translating service. The applicant has applied for a capacity of eight (8). The home consists of four (4) bedrooms and three (3) bathrooms. The applicant will be using the following areas for daycare: Family Room, kitchen, backyard. Off limit areas include: Living room, dining room, all upstairs, garage and front yard. Outdoor play area is fenced, however their fencing does not meet the concrete and leaves the area accessible to children to climb under. There is a pool in the backyard with a 5 foot fence which has a gate that swings away from the pool, however the pool gate does not self latch/close. The backyard also has a swing set which is not secured to the ground. The front of the home has a large pond which has water in it. Fencing measures just under 3 feet in height and there is a gate with a latch but does not self latch/close. Applicant states that the front pond is to be filled in within the next month or later. Business Hours are Monday through Saturday, 7am to 10pm. An overall inspection of the home was conducted. The inspection included, but was not limited to:

The home does not have a functioning carbon monoxide / smoke detector. Applicant does have a fire extinguisher that meet statutory requirements. There is a fire place which is screened and inaccessible. The home does not have any open faced heaters but rather central heat/air. Storage areas for poisons, detergents, cleaning solutions, medications and items which state keep out of reach of children have been locked and inaccessible. Applicant, Khammi advised there are no firearms or ammunition stored on the premises. The home is kept clean with heating and ventilation for safety and comfort. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. The home provides safe toys, play equipment and materials.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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 3
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: KHAMMI, GHADA FAMILY CHILD CARE
FACILITY NUMBER: 376100800
VISIT DATE: 10/13/2021
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The new provider packet was reviewed with the applicant including information on children’s records, immunizations, child abuse reporting, car seat laws, shaken baby syndrome, SIDS, safe sleep and the effects of lead poisoning. Also included was information on Incidental Medical Services and the YMCA Resource Center.

Applicant stated they have enough financial resources to sustain the license. Applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall not be permitted during daycare operation. All equipment that is used should be used only as intended by the manufacturer. Applicant Khammi states they are aware that interference with a child’s daily functions, physical or mental abuse and corporal punishment is not permitted. LPA and applicant discussed California Megan’s Law and LPA provided the link www.meganslaw.ca.gov.

LPA discussed safe sleep regulations with licensee or facility representative 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/facility representative 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 CPSC to be notified of any recalls on their purchased equipment

LPA discussed the following with the applicant: Maximum capacity for a small family child care home; 4 infants only (infants defined as children under 24 months) or 6 children with no more than 3 infants; or with landlord consent, 8 children with no more than 2 infants – 1 child in kindergarten or elementary school and 1 child at least age 6 including children under the age of 10 who reside in the applicant’s home.

All individuals subject to a criminal record review have obtained a clearance and/or an exemption prior working, residing or volunteering in the home. The applicant was reminded that all adults 18 years and over living or working in the home, including employees or 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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
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: KHAMMI, GHADA FAMILY CHILD CARE
FACILITY NUMBER: 376100800
VISIT DATE: 10/13/2021
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A civil penalty of $100.00 minimum/day up to $500 maximum per day/per person will be assessed if there is regulation is violated. The applicant has completed training on preventive health practices including pediatric CPR and First Aid. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

LPA provided the applicant with the following: Child Care Advocates email address of childcareadvocatesprogram@dss.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 following items will need to be corrected prior to the issuance of the license: Pool and backyard fencing corrections, securing the swing set, emptying and securing the area around the front pond, carbon monoxide detector/smoke detector installed. Once all corrections have been made, and proof has been received in the licensing office, a license for eight (8) children will be granted. Applicant agreed to comply with all regulations and laws governing Family Child Care Homes. Additional Technical Assistance was provided and noted on the attached Advisory Note – Technical Assistance (LIC 9102).
An exit interview conducted and report was reviewed with applicant, Khammi. 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: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
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