376100905-4-6-2023-51-CC-JLOT-CQN2C5-20230406171611

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100905
Report Date: 04/06/2023
Date Signed: 04/06/2023 05:16:17 PM

Document Has Been Signed on 04/06/2023 05:16 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:	TAHSIL DOST, AMINA & SHAKIR FAMILY CHILD CARE		FACILITY NUMBER:	376100905
ADMINISTRATOR:	AMINA & SHAKIR T.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 494-7305
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	04/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	07:52 AM
MET WITH:	Licensee, Shakir Tahsil Dost		TIME COMPLETED:	09:50 AM

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	Licensing Program Analyst (LPA), Jennifer Lott conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door by Licensee, Shakir Tahsil Dost and granted entry after identifying herself and disclosing the purpose of her visit. The licensee is using the following areas for daycare: Living room, family room, dining room, kitchen, lower backyard, bedroom #1 and downstairs bathroom. Off limit areas include: Bedroom 2-3, upstairs bathroom/bedroom, garage, front yard, upper back yard. The facility currently has 0 children in care. Licensee was unable to provide a copy of their current roster, however they are operating within the licensed ratio and capacity. At 8:15am LPA/Licensee tested the smoke detector/carbon monoxide detector located in the hallway/living room area. Both devices were functional. There are no pools/bodies of water on the premises. There are no weapons or ammunition stored in the home. There is a fireplace which is screened to prevent access. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. Upper back yard is currently off limits until a gate/barricade is placed at the bottom of the stairs. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible. Outdoor play area is fenced and free of hazards. The last disaster/fire drill was conducted on 03/04/2023. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials. Children’s records were incomplete. Pediatric CPR and First Aid cards are current and will expire on 05/2023. Mandated reporter training was waived as the licensee's primary language is Pashtu. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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: TAHSIL DOST, AMINA & SHAKIR FAMILY CHILD CARE	FACILITY NUMBER: 376100905
	VISIT DATE: 04/06/2023

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain 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 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 for 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 the CPSC to be notified of any recalls on their purchased equipment.

Licensee states that they do not provide medication assistance to any day care children. 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to: inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on today’s visit, deficiencies were observed and noted on the attached LIC 809D. Exit interview conducted and report was reviewed with Licensee, Tahsil Dost. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/06/2023 05:16 PM - It Cannot Be Edited

Created By: Jennifer Lott On 04/06/2023 at 09:17 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: TAHSIL DOST, AMINA & SHAKIR FAMILY CHILD CARE	FACILITY NUMBER: 376100905
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on lPA's record review, the licensee did not comply with the section cited above in 9:9 children's files were incomplete which poses a potential health & safety risk to persons in care.
	POC Due Date: 05/01/2023
	Plan of Correction
1 2 3 4	Licensee states they will complete 9:9 children's files. Licensee will submit proof to CCL via fax or email by POC date.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [LPA's record review, the licensee did not comply with the section cited above by not having a children's roster for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/01/2023
	Plan of Correction
1 2 3 4	Licensee states they will complete a facility roster and subit a copy to CCL by POC date via fax or email.

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:

Tashima Daniel

LICENSING EVALUATOR NAME:

Jennifer Lott

LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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