376101318-2-10-2023-51-CC-KLAE-CNWVQL-20230210153832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376101318
Report Date: 02/10/2023
Date Signed: 02/10/2023 03:38:52 PM

Document Has Been Signed on 02/10/2023 03:38 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:	ALI, MUNISA FAMILY CHILD CARE		FACILITY NUMBER:	376101318
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	02/10/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Munisa Ali		TIME COMPLETED:	03:45 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 2/10/23 at 1:20 PM, Licensing Program Analysts (LPAs) Keturah Lane and Sherlynn Banas, conducted an announced Pre-Licensing inspection for the applicant. Upon arrival, LPAs met with applicant Munisa Ali and also present were Licensee’s adult children Sakariye Musse, Subayda Musse and Sumaya Musse and applicant’s minor son. The two-story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke detector meet requirements and are operational. The carbon monoxide detector was not functioning. Applicant stated she would obtain a new detector. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home. The fireplace and staircase are barricaded. There is a working phone at the facility. Applicant states that there are no weapons in the home. Applicant states that they have sufficient financial resources to sustain the license. CPR and First Aid expire 7/2024. Preventative health practices course was completed on 7/24/22 which includes lead poison prevention training. Mandated reporter training was completed on 8/18/22 and expires on 8/18/24. Staff immunization requirements were met. Required documents have been posted. The applicant has toys and equipment available. Applicant will be using the following rooms for childcare: living room, family room, dining room, kitchen and bathroom. Off-limits areas include: garage and entire second story which includes four bedrooms and 2 bathrooms and are inaccessible through the use of a gate at the bottom of the stairs and door knob cover on garage door. Applicant has a fully fenced backyard and front yard available for outdoor activities. LPAs observed several portions of the wooden fence that need repair in the backyard. Applicant stated she would fix the fence and send video to LPA Lane. Applicant stated the trampoline in the backyard will be off-limits. Applicant rents the home. Verification of control of property is on file. Property owner/Landlord notification is on file, but no landlord consent was provided. (continued on LIC809-C...)

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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: ALI, MUNISA FAMILY CHILD CARE	FACILITY NUMBER: 376101318
	VISIT DATE: 02/10/2023

NARRATIVE

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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.

LPAs 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. The new provider packet was reviewed with the applicant including information on child abuse and unusual incident reporting. LPAs provided information regarding 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. LPAs and applicant discussed Shaken Baby Syndrome and California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Lane reviewed COVID-19 guidelines with Applicant and provided COVID-19 resources.

LPAs 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-and-resources/safe-sleep as an additional resource. LPAs 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.

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.

(continued on LIC809-C...)

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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: ALI, MUNISA FAMILY CHILD CARE	FACILITY NUMBER: 376101318
	VISIT DATE: 02/10/2023

NARRATIVE

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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 corrections are needed prior to the issuance of the license:
1. Obtain functioning carbon monoxide detector
2. Repair broken fence in 5 areas discussed with applicant

Once all corrections are made and proof is sent to licensing a license for 8 children may be granted. Applicant understands that proof of corrections must be submitted to Licensing within 30 days or the application may be denied. Applicant understands that she must obtain landlord consent to care for more than 6 children. Applicant agreed to comply with all regulations and laws governing family child-care homes.

Exit interview conducted and report was reviewed with the applicant Munisa Ali.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC809 (FAS) - (06/04)

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