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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100948
Report Date: 04/06/2023
Date Signed: 04/19/2023 05:06:31 PM

Document Has Been Signed on 04/19/2023 05:06 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:RAZIQI, SHABANA & JAMAL FAMILY CHILD CAREFACILITY NUMBER:
376100948
ADMINISTRATOR:SHABANA & JAMAL R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 494-6703
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 1DATE:
04/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensee, Shabana RaziqiTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Jennifer Lott conducted an unannounced Annual Licensing Inspection. LPA was greeted at the front door Licensee, Shabana Raziqu and Jamal Raziqi 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, kitchen and downstairs bathroom. Off limit areas include: All upstairs, garage, front and back yard. Outdoor play will take place at a near by park with constant supervision. The facility has 1 child in care only which was the licensee's own child. Licensee provided a copy of their current roster and is operating within the licensed ratio and capacity.

At 1:00pm, LPA/Licensee tested the carbon monoxide and smoke detector located in the kitchen and hallway areas. 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 are no open face heaters/fireplaces. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible to children. The last disaster/fire drill was conducted on 02/23/2023. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials.
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: RAZIQI, SHABANA & JAMAL FAMILY CHILD CARE
FACILITY NUMBER: 376100948
VISIT DATE: 04/06/2023
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Children’s records contained emergency contact information and immunization records. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights. Pediatric CPR and First Aid cards expired 08/2022. All staff have completed the mandated Child Abuse Reporting as per AB1207 through 06/2023. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

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 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 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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023
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: RAZIQI, SHABANA & JAMAL FAMILY CHILD CARE
FACILITY NUMBER: 376100948
VISIT DATE: 04/06/2023
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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 Raziqi. 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: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/19/2023 05:06 PM - It Cannot Be Edited


Created By: Jennifer Lott On 04/19/2023 at 02:08 PM
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: RAZIQI, SHABANA & JAMAL FAMILY CHILD CARE
FACILITY NUMBER: 376100948

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)

Personnel Requirements - ...The licensee and other personnel as specified shall complete training on preventative health practices including pediatric cardiopulmonary resucitation and pediatric first aid...
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's record review, the licensee did not comply with the section cited above in 2:2 staff Pediatric First Aid/CPR certificates expired on 08/2022 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/08/2023
Plan of Correction
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Licensee states that both staff will complete the Pediatric First Aid/CPR training and submit copies of the 2 certificates to LPA via fax or email by POC date.
Type B
Section Cited
CCR
102425(a)
Infant Safe Sleep - ...There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observations, the licensee did not comply with the section cited above by not providing a crib or play yard for 1:1 infant in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/08/2023
Plan of Correction
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Licensee states that they will purchase a crib or play yard for 1:1 infants in care. Proof of purchase and photo will be submitted to LPA via fax or email by POC date.
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: 04/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023


LIC809 (FAS) - (06/04)
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