376100987-3-1-2022-51-CC-ALMA-CC4PSU-20220301103456

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100987
Report Date: 03/01/2022
Date Signed: 03/01/2022 10:35:05 AM

Document Has Been Signed on 03/01/2022 10:35 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:	MONQAD, GULSOOM FAMILY CHILD CARE		FACILITY NUMBER:	376100987
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	03/01/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Gulsoom Monqad		TIME COMPLETED:	10:50 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	On 3/1/22 at 8:40 AM, Licensing Program Analyst (LPA) Adrian Mangina conducted an announced change of location inspection with the applicant. Also present in the home during the inspection was Applicant’s husband Atiqullah Monqad, who provided translation and one minor child. The 5-bedroom, 4- bathroom two story home was toured and inspected to ensure an environment safe for the care and supervision of children. A copy of the mortgage billing statement was provided as proof of control of property. Applicant states that they have sufficient financial resources to sustain the license. 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. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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. Applicant agreed to comply with all regulations and laws governing family child-care homes. First Aid and CPR expires on 10/25/22. Licensee previously completed preventative health practices Course on 11/13/16. Lead Poisoning Training supplement course was completed on 2/17/22 . Mandated Reporter Training AB 1207 was waived due to Licensee’s first language is not English. Staff immunization requirements per SB792 were met. Applicant has the required immunizations. Applicant states that there are no weapons in the home (continued on LIC809 page 2)

SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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: MONQAD, GULSOOM FAMILY CHILD CARE	FACILITY NUMBER: 376100987
	VISIT DATE: 03/01/2022

NARRATIVE

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(LIC809 page)

Applicant will be using the following rooms for childcare: room 1, living room, dining room, kitchen, hallway, bathroom 1 and bathroom 2. The following areas will be off limits: second floor and yard. The off-limit areas either have safety latches, locks, doorknob covers or gates to prevent access. The attached garage will also be off limits and is kept inaccessible through the use of a doorknob cover. The fireplace located in the living room is screened to prevent access. There are no bodies of water on the property.

The #3A40BC fire extinguisher located in the kitchen and the combination smoke detector/carbon monoxide detector located in kitchen meet requirements and are all operational. All hazardous items were latched/locked and secured out of reach of children. The applicant has sufficient toys and equipment available. Outdoor play area is the neighborhood park. Visual supervision is required at all times when children are outside.

The new provider packet was reviewed with the applicant including information on ratios and capacity, child abuse reporting, children’s records, immunizations, adults living or working in the home, car seat law, shaken baby syndrome, SIDS, safe sleep practices, effects of lead poisoning, and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers, and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided applicant with the following information:
· Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov.
· For common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.
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
(continued on LIC809 page 3)

SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

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: MONQAD, GULSOOM FAMILY CHILD CARE	FACILITY NUMBER: 376100987
	VISIT DATE: 03/01/2022

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(LIC809 page 3)
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.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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

LPA reviewed with applicant, the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed prior to the issuance of the license:

1) Posting of all required documents
2) Submit LIC999A for second floor

Applicant understands that corrections must be submitted to the Department within 30 days, no later than 3/31/22, or the application may be denied.

Exit interview conducted and report was reviewed with and provided to the Applicant Gulsoom Monqad.

SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2022

LIC809 (FAS) - (06/04)

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