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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376611899
Report Date: 07/12/2021
Date Signed: 07/12/2021 03:37:17 PM

Document Has Been Signed on 07/12/2021 03:37 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:MIRAN, JWAN FAMILY CHILD CAREFACILITY NUMBER:
376611899
ADMINISTRATOR:JWAN MIRANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 917-5701
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee, Jwan Miran TIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Jennifer Lott and Annette Sutherland conducted an unannounced Annual Licensing Inspection. LPAs were greeted at the front door by Liensee, Jwan Miran and granted entry after identifying themselves and disclosing the purpose of their visit. The licensee is using the following areas for daycare: Kitchen, dining room, living room, family room, downstairs bathroom and playroom. Patio is used with older children. Off limit areas include: All upstairs, patio with young children. Business Hours are: M-F 6a-6p. The facility currently has 0 children in care at this time. Licensee is operating within the licensed ratio and capacity.

The home has one or more functioning carbon monoxide detectors, smoke detector and fire extinguisher that meet statutory requirements. The fireplace is screened to prevent access by children. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. Storage for poisons, detergents, cleaning solutions, medications are locked and inaccessible to children. Licensee advised there are no bodies of water on the premises. Outdoor play area is fenced and free of hazards. Licensee, Jwan advised there are no firearms or ammunition stored on the premises. The last disaster/fire drill has not been conducted since 2017. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials.

Children’s records contained emergency contact information and immunization records. All parents or representatives received a copy of the Family Child Care Home Notification of Parent’s Rights.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2021
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: MIRAN, JWAN FAMILY CHILD CARE
FACILITY NUMBER: 376611899
VISIT DATE: 07/12/2021
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All individuals subject to a criminal record review have obtained a clearance and/or an exemption prior working/residing in the home. Pediatric CPR and First Aid cards are current and will expire on 11/16/2021. Licensee was exempt from the mandated Child Abuse Reporting as per AB1207 as Kurdish is their primary language. Staff immunizations were reviewed and are in compliance. There is a working telephone and email address.

LPA reviewed the following with Licensee, Miran: Safe Sleep Regulation Concept Handout, Car Seat Law, Effects of Lead Exposure, SIDS and Shaken Baby Syndrome. Licensee was reminded that corporal punishment, smoking, walkers, jumpers, exersaucers and bouncy seats shall never be permitted during daycare operation. Licensee Miran states they are aware that interference with a child’s daily functions, physical or mental abuse and corporal punishment is not permitted. Licensee has also been reminded that anything that states, “Keep out of reach of children” is to be inaccessible to children.

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.

Based on today’s visit, deficiencies were observed and noted on the attached LIC 809D. An exit interview was conducted with Licensee, Miran. A copy of this report, Appeal and Licensee Rights (LIC 9058) as well as Notice of Site Visit Form (LIC 9213) have been provided. Signature below confirms receipt of these documents. Licensee acknowledges that the LIC 9213 is required to be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/12/2021 03:37 PM - It Cannot Be Edited


Created By: Jennifer Lott On 07/12/2021 at 02:32 PM
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: MIRAN, JWAN FAMILY CHILD CARE
FACILITY NUMBER: 376611899

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2021
Section Cited
CCR
102417(g)(9)(A)(1)

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Operation of a Family Child Care - ...Each family child care home shall conduct fire drills and disaster drills at least once every six months.The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home....This requirement is not met as evidenced by:
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Licensee states they will complete the fire/disaster drill and submit proof of completion to LPA by POC date via fax or email.
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Based on LPA's record review, the licensee did not complete the required fire/disaster drill every 6 months. This poses a potential safety risk to children 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:Tashima Daniel
LICENSING EVALUATOR NAME:Jennifer Lott
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2021


LIC809 (FAS) - (06/04)
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