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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101847
Report Date: 03/22/2024
Date Signed: 03/22/2024 12:11:10 PM

Document Has Been Signed on 03/22/2024 12:11 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:GHARZ EDDIN, RASHA FAMILY CHILD CAREFACILITY NUMBER:
376101847
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
03/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rasha Gharz Eddin TIME COMPLETED:
12:30 PM
NARRATIVE
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On 3/22/24 at 9:15 am, Licensing Program Analyst (LPA) Gerald Poindexter conducted an unannounced inspection for an Increase in Capacity application. LPA met with licensee Rasha Gharz Eddin. Fire clearance report was provided to the Department on 3/13/24. Present in the home were two of the licensee’s minor children. There were no day care children present in the home at the time of inspection. The three-bedroom, two-bath, two-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Licensee states the currently enrolled children begin to arrive at approximately 12 pm. Hours of operation is seven days per week, 6 am to 10 pm.

Areas used for childcare include the following areas: living room, dining room, kitchen, bedroom #1, and bathroom #1. Off limit areas include Bedroom #2, Master bedroom and master bathroom, attic, laundry room, and backyard. Off-limit areas have been made inaccessible with the use of doorknob covers and safety gates. The licensee has sufficient toys and equipment available.

The home has a fenced/gated back patio and yard and front yard area available for outdoor activities. Licensee states that these areas are off limits. LPA observed that the outdoor areas are made inaccessible by door locks. LPA reminded licensee to inform the Department if these outdoor areas are used for child care. Licensee states she will take children to a nearby park for outdoor activities and understands that supervision is required at all times during outdoor activities. The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. Some, but not all hazardous items were secured out of reach of children (see LIC9102) through latches/locks and high placement. There is no body of water on the property. Licensee states that there are no weapons in the home. Pediatric First Aid and CPR certifications for licensee expire on 01/2025. LPA advised licensee of all helper/aide requirements. Licensee has required immunizations. Applicant is exempt from Mandated Reporter Training as Arabic is primary language.

CONTINUED ON PAGE 2

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: GHARZ EDDIN, RASHA FAMILY CHILD CARE
FACILITY NUMBER: 376101847
VISIT DATE: 03/22/2024
NARRATIVE
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LPA observed all required postings were posted. Children’s records were reviewed and found to be incomplete. Staff records were reviewed. Licensee maintains a current roster of the children which LPA obtained during time of inspection.

Licensee moved into the residence with the past three months and LPA reminded her that emergency drills must be conducted and documented every six months. LPA verified that all adults living or working in the home have been fingerprint cleared and associated. LPA reminded Licensee that all unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203. Duty officer number is (619)767-2248.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer.

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.



Licensee was reminded that all adults 18 and over living or working in the home, 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.

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SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
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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: GHARZ EDDIN, RASHA FAMILY CHILD CARE
FACILITY NUMBER: 376101847
VISIT DATE: 03/22/2024
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The Licensee rents the home and provided proof of control of property. Capacity limitations were reviewed. Licensee is to be present in the home to ensure children are supervised and is reminded that the license is NOT transferable and should she relocate, this license will be null and void.

See 809D for deficiencies cited

A license for 14 children may be issued upon completion of Plan of Correction. Licensee was reminded that annual fees are due on the date they were licensee every year.

Exit interview conducted and report was reviewed with the licensee Rasha Gharz Eddin. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/22/2024 12:11 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 03/22/2024 at 10:58 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: GHARZ EDDIN, RASHA FAMILY CHILD CARE
FACILITY NUMBER: 376101847

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2024
Section Cited
CCR
102425(c)

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102425 INFANT SAFE SLEEP
(c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.

This requirement is not met as evidenced by:
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The licensee states that she will submit completed Infant Sleep Plan, LIC9227 for C5 to LPA via email by 4/1/24.
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Based on record review and licensee statement, the licensee did not comply with the section cited above in 1 out of 1 infant under 12 months do not have a completed Infant Sleep Plan (LIC9227) on file. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/22/2024
Section Cited
CCR102425(j)(2)(D)(c)

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102425 INFANT SAFE SLEEP
(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (2) The provider shall check and document the following: (D)Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:c. Time of each 15-minute check.
This requirement is not met as evidenced by:
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Based on record review and licensee statement, the licensee did not comply with the section cited above in 1 out of 1 infants files reviewed do not contain 15 minute sleep documentation. This poses a potential health, safety or personal rights risk to persons in care.
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LPA reviewed Safe Sleep Log documentation with the licensee. The licensee states that she will submit completed15-minute sleep documentation for C5 to LPA via email by 4/1/24.
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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024


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Document Has Been Signed on 03/22/2024 12:11 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 03/22/2024 at 11:11 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: GHARZ EDDIN, RASHA FAMILY CHILD CARE
FACILITY NUMBER: 376101847

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2024
Section Cited
CCR
102417(g)(7)

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(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

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The licensee states that he will submit completed and signed consent for emergency medical treatment forms (LIC627) for the five children enrolled (C1-C5) to LPA via email by 4/1/24.
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Based on record review, the licensee did not comply with the section cited above in 5 out of 5 children's files reviewed do not contain completed and signed consent for emergency medical treatment forms. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/22/2024
Section Cited
CCR102417(m)(3)

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(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.
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This licensee states that she will submit completed and signed insurance affidavits, LIC282 (Sections A and B), for C1-C5 to LPA via email by 4/1/24.
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Based on record review, the licensee did not comply with the section cited above in 5 out of 5 files reviewed do not contain completed insurance affidavits (LIC282)for the licensee's current home. This poses a potential health, safety or personal rights risk to persons in care.
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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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024


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