376101637-4-3-2024-51-CC-MAVA-D3YVCK-20240403161916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376101637
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:19:30 PM

Document Has Been Signed on 04/03/2024 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	POLUS, SAHAR FAMILY CHILD CARE		FACILITY NUMBER:	376101637
ADMINISTRATOR: ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/03/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN: TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Sahar Polus		TIME COMPLETED: TIME VISIT/ INSPECTION COMPLETED:	04:30 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 4/3/24 at 1:30 PM, Licensing Program Analysts (LPAs) Martha Avila and Nancy Diaz, conducted an announced Pre-Licensing inspection for the applicant. Upon arrival, LPA met with applicant Sahar Polus and also present were two grandchildren (minors), applicant's sister Silvana Polus, and Sama Polus applicant's daughter who translated in Arabic. The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. The home has 3 bedrooms and 2 bathrooms, and a guest home in the backyard. The fire extinguisher and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. The fireplace is screened. 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 on July 2025. Preventative health practices course was completed on November 11, 2023 which includes lead poison prevention training. Mandated Reporter Training was completed on June 25, 2023. Staff immunization requirements were met. The applicant has toys and equipment available. Applicant will be using the following rooms for childcare: Kitchen, dining area, family room, hallway bathroom, and Licensee's bedroom. Off-limits areas include: living room, bedroom #2, bedroom #3, bathroom #2, basement, patio, and guest house located in the back of house. The bedrooms are inaccessible through the use of doorknob covers. The garage will also be off limits and is kept inaccessible through the use doorknob cover. Applicant has a (fully fenced) backyard available, however part of the backyard will be off limits to children.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Martha Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: POLUS, SAHAR FAMILY CHILD CARE	FACILITY NUMBER: 376101637
	VISIT DATE: 04/03/2024

NARRATIVE

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The new provider packet was reviewed with the applicant including information on child abuse and unusual incident reporting. LPA 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.

The applicant provided proof of control of property. Because the applicant owns her home, proof of a mortgage bill was provided.

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.

LPA 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-andresources/safe-sleep, as an 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.

On this date, 04/03/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Martha Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: POLUS, SAHAR FAMILY CHILD CARE	FACILITY NUMBER: 376101637
	VISIT DATE: 04/03/2024

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

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) or (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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Martha Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: POLUS, SAHAR FAMILY CHILD CARE	FACILITY NUMBER: 376101637
	VISIT DATE: 04/03/2024

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

Update facility sketch (LIC999). Facility sketch submitted did not include bedroom #1.
Install barricade to make living room inaccessible from the family room and kitchen.
Obtain a regulation required carbon monoxide detector.
Install screw lock to sliding door to make patio area inaccessible to children.
Obtain livescan fingerprint clearance and TB tests for Josie Ana Edenshaw and Methqal Aldeen Alghzaw (residents living in the guest house).
Make trampoline inaccessible to children or remove from backyard.
Remove water from the 3 water fountains and make them inaccessible to children.
Make the white tiered water fountain inaccessible to children via 5 feet fencing.
Remove all construction materials from the front and backyard.
Cover bar-b-que grill.
Remove over grown weeds from the backyard.
Remove bar-b-que skewers and propane tank from backyard.
Make the deer statue (sharp antlers) inaccessible to children.
Remove propane tank and cover red bar-b-que grill located in front of the guest home.
Place doorknob covers to the storage shed to make chemicals inaccessible to children.
Post required documents. (LIC 999, LIC610, PUB 394, fire drill log, car seat log, LIC9148).

Applicant was reminded that all future residents in the guest home obtain livescan fingerprint clearance and to be TB tested prior to moving in.

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 agreed to comply with all regulations and laws governing family child-care homes.

Exit interview conducted and report was reviewed with the applicant, Sahar Polus.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Martha Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC809 (FAS) - (06/04)

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