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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101926
Report Date: 03/07/2024
Date Signed: 03/07/2024 01:29:05 PM

Document Has Been Signed on 03/07/2024 01:29 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:SAMIULLAH, ZOYA FAMILY CHILD CAREFACILITY NUMBER:
376101926
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
03/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Zoya Samiullah TIME COMPLETED:
02:10 PM
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On 3/7/24 at 12:30 PM, Licensing Program Analyst (LPA) Annette Sutherland conducted a change of location pre-licensing inspection. Upon arrival, LPA was greeted by applicant Zoya Samiullah. Also present was the licensee’s husband Sami Samiullah and minor child. Family friend help translate via phone. The 3-bedroom, 3 bathrooms, two story home was toured and inspected to ensure an environment safe for the care and supervision of children.
The applicant has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include the following areas: Living room, bathroom #1 and backyard. Off limit areas include Kitchen, Garage, and entire upstairs. Off-limit areas have been made inaccessible with the use of doorknob covers and safety gates. The facility has sufficient toys and equipment available. Fire place is barricaded. There is a fully charged fire extinguisher, smoke and carbon monoxide detector that meet requirements and are operational. Poisons, cleaning compounds, medications and other hazardous items are inaccessible. Adequate heating and ventilation are provided. There is a working telephone. Applicant stated there are no firearms and weapons in the home. No bodies of water on property.
A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal records and child abuse clearances or exemptions. Applicant rents the home and has provided proof of control of property and the Landlord Notification. First Aid and CPR expire in April 2024.
The licensee is exempt from Mandated Reporter Training due to the language barrier. Staff immunization requirements per SB792 were met. All required postings are posted.
LPA informed Applicant 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. The duty officer number is (619)767-2248. 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.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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: SAMIULLAH, ZOYA FAMILY CHILD CARE
FACILITY NUMBER: 376101926
VISIT DATE: 03/07/2024
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Applicant was reminded of requirements for children’s records, facility roster, child abuse and unusual incident reporting, immunization's, car seat law, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, baby walkers, exersaucers, bouncy seats and baby jumpers are not allowed in day care. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.
Applicant shall comply with all regulations and laws governing family childcare homes and be financially secure to operate a family childcare home for children. 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.
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.
LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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, 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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: SAMIULLAH, ZOYA FAMILY CHILD CARE
FACILITY NUMBER: 376101926
VISIT DATE: 03/07/2024
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The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

No corrections are needed.

A license for 8 children may be issued upon final file review. The licensee was reminded that annual fees are due on the date they were licensed every year. An exit interview was conducted with Licensee. Appeal Rights (LIC9058) was given along with the report (LIC809) to the Licensee.

Exit interview conducted and report was reviewed with the licensee. During the exit interview, the License, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. An exit interview was conducted with the applicant. Appeal Rights (LIC9058) were provided.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC809 (FAS) - (06/04)
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