376617315-8-12-2022-51-CC-ALMA-CH8U4T-20220812151539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376617315
Report Date: 08/12/2022
Date Signed: 08/12/2022 03:15:48 PM

Document Has Been Signed on 08/12/2022 03:15 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:	JAMA, KADIJA FAMILY CHILD CARE		FACILITY NUMBER:	376617315
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	08/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Kadija Jama		TIME COMPLETED:	03:45 PM

NARRATIVE

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On 8/12/22 at 1:10 PM Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Annual inspection with the Licensee. Upon arrival, LPA met with Licensee, Kadija Jama. The three bedroom two bathroom two story apartment was toured and inspected to ensure an environment safe for the care and supervision of children. Also present in the home was Licensee’s daughter Hawokin Mumin who was visiting with her four children. Hawokin left at 2:00 PM and left her children in the care of Licensee. At approximately 1:45 PM two additional children in care arrived. Proper supervision and ratios were observed. The 2A10 BC fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water on the property. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. 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.

Licensee’s First Aid and CPR certifications expire on 6/23. Licensee meets immunization requirements and has completed Mandated Reporter Training which expires 11/30/23. LPA reviewed one child file. 2:15 LPA observed that five of six children have no child files.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include:living room, kitchen, bathroom, and dining room. Off limits areas include: entire second

(continued on LIC809 page 2)

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

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: JAMA, KADIJA FAMILY CHILD CARE	FACILITY NUMBER: 376617315
	VISIT DATE: 08/12/2022

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LIC809 page 2

floor and are inaccessible through use of gate at bottom of stairs. There is a working phone at the facility. The licensee has sufficient age appropriate, safe, toys and equipment available. The home has a fully fenced backyard available for outdoor activities.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances associated to the facility, 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 and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Mangina reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA Mangina directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

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.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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. LPA also informed licensee [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.

(continued on LIOC809 page 3)

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

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: JAMA, KADIJA FAMILY CHILD CARE	FACILITY NUMBER: 376617315
	VISIT DATE: 08/12/2022

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LIC809 page 3

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

See LIC 809-D for type B deficiencies cited.

Exit interview conducted and report was reviewed with the licensee [or facility representative] (include name). The Licensee was provided a copy of this report. A Notice of Site Visit (LIC9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/12/2022 03:15 PM - It Cannot Be Edited

Created By: Adrian L Mangina On 08/12/2022 at 03:02 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: JAMA, KADIJA FAMILY CHILD CARE	FACILITY NUMBER: 376617315
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited as LIcensee does not have child files for five of six children which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/26/2022
	Plan of Correction
1 2 3 4	Licensee states will ensure all children in care have complete child files.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Renesha Askew

LICENSING EVALUATOR NAME:

Adrian L Mangina

LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022

LIC809 (FAS) - (06/04)

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