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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376617315
Report Date: 05/12/2023
Date Signed: 05/12/2023 10:28:46 AM

Document Has Been Signed on 05/12/2023 10:28 AM - 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 CAREFACILITY NUMBER:
376617315
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/12/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Kadija JamaTIME COMPLETED:
10:50 AM
NARRATIVE
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On 5/12/23 at 8:45am Licensing Program Analysts (LPAs) Patrick Ma and Gerald Poindexter conducted a Case Management Inspection for increase in capacity application. Fire clearance was completed on 3/21/23. Also, in the home was adult daughter Ifrah Mumin. Daughter helped translate in Somali during the inspection. The 2 story apartment was toured and inspected to ensure an environment safe for the care and supervision of children. There were no children in care. Licensee states they typically arrive after 11:30am.

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, dining room, and backyard. Off limits areas include entire second floor and requires a gate or barricade to make inaccessible during child care. The licensee has sufficient toys and equipment available. The home has a full fenced backyard available for outdoor activities. Licensee 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. All hazardous items were latched/locked and secured out of reach of children. There is no body of water on the property. Licensee states that there are no weapons in the home. First Aid and CPR certifications expire on 5/4/25. Licensee has required immunizations. Licensee is exempt from Mandated Reporter Training as their primary language is Somali. Children’s and Staff records were reviewed.

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.

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.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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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Document Has Been Signed on 05/12/2023 10:28 AM - It Cannot Be Edited


Created By: Patrick Ma On 05/12/2023 at 09:49 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: JAMA, KADIJA FAMILY CHILD CARE
FACILITY NUMBER: 376617315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited
CCR
102416.1

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102416.1 Personnel records shall be maintained on each employee...
This requirement was not met as evidenced by:
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Licensee stated she will provide proof of all completed helper documents for daughter/helper by 5/26/23.
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Based on file review, the licensee stated adult daughter have helped in the past but there was no helper records on file in the home, which poses a potential health and safety risk to children in care.
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Type B
05/26/2023
Section Cited
CCR102417(g)(3)

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102417(g)(3) Where children less than five years old are in care, stairs shall be fenced or barricaded.
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Licensee stated they will barricade the stairs temporarily when children are in care with furniture before they can purchase a gate show proof by 5/26/23.
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Based on observation, Licensee did not have an operational gate available to barricade the stairs.
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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:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023


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: 05/12/2023
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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 they relocate, this license will be null and void.

See LIC809D for deficiencies cited.

The following corrections are needed:

• Backyard has garbage debris and clutter of bikes creating a hazard
• Helper files for daughter/helper Ifrah Mumin
• Backyard gate exit needs to be made inaccessible to children
• Stairs need to be barricaded or gated

Applicant understands that corrections must be submitted to the Department within 30 days or the application may be denied.

Exit interview conducted and report was reviewed with the applicant Kadija Jama. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
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