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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623057
Report Date: 08/14/2024
Date Signed: 08/14/2024 04:19:43 PM

Document Has Been Signed on 08/14/2024 04:19 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:OSMAN, FOWSIA FAMILY CHILD CAREFACILITY NUMBER:
376623057
ADMINISTRATOR/
DIRECTOR:		FOWSIA OSMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 399-5009
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee Fowsia OsmanTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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On 08/14/2024 at 2:00 pm, Licensing Program Analyst (LPA), Michelle Hood conducted an unannounced Annual Required Inspection and met with Licensee Fowsia Osman. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. There were two children present in the facility during this inspection. The licensee accompanied LPA inside and out of the facility during this inspection. The off-limits areas are inaccessible using door knob covers. Per the licensee, she is open 24 hours a day, Monday through Sunday.

The fire extinguisher, smoke detector, and carbon monoxide detector met the requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment, and materials available. The licensee uses the backyard for outdoor play. The licensee understands there must be direct supervision while the children are outdoors. No bodies of water were observed on the premises during the inspection. 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. Licensee’s First Aid and CPR certifications expire on 10/2024. The licensee has required immunizations. Licensee is exempt from Mandated Reporter Training due to her first language is Somali. The facility roster is maintained and reviewed. LPA reviewed children’s files. The last fire and disaster drills were conducted and documented on 06/24/2024.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: OSMAN, FOWSIA FAMILY CHILD CARE
FACILITY NUMBER: 376623057
VISIT DATE: 08/14/2024
NARRATIVE
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LPA discussed the following: Reporting Covid positive, suspected child abuse & neglect, maintaining children’s records according to regulation, and post required forms. The licensee was reminded corporal punishment, smoking, exersaucers, bouncy seats, walkers, jumpers, and/or similar equipment are not allowed in daycare. The licensee stated she does not care for children under 24 months. During the exit interview, the Licensee Fowsia Osman, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. LPA provided the California Megan's Law website: www.meganslaw.ca.gov. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

LPA Hood informed licensee Fowsia Osman that this report dated 08/13/2024 document one (1) Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Hood informed the licensee Fowsia Osman to provide a copy of this licensing report dated 08/14/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted, and the report was reviewed with the licensee Fowsia Osman. The licensee was provided with a copy of their appeal rights (LIC 9058 03/22) and their signature on this form acknowledges receipt of these rights. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. See the LIC 809 D page for deficiencies.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/14/2024 04:19 PM - It Cannot Be Edited


Created By: Michelle Hood On 08/14/2024 at 03:37 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: OSMAN, FOWSIA FAMILY CHILD CARE
FACILITY NUMBER: 376623057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(k)
Criminal Record Clearance
(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, and record review, the licensee did not comply with the section cited above in one out of one person which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2024
Plan of Correction
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The licensee will have her adult son fingerprinted and submit the paperwork to the LPA no later than 08/15/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Cynthia Gray
LICENSING EVALUATOR NAME:Michelle Hood
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/14/2024 04:19 PM - It Cannot Be Edited


Created By: Michelle Hood On 08/14/2024 at 03:37 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: OSMAN, FOWSIA FAMILY CHILD CARE
FACILITY NUMBER: 376623057

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in three (3) out of three (3) children did not have the LIC 700 form, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2024
Plan of Correction
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The licensee stated she will have the parent submit the LIC 700 form to the LPA on the next day of care for the three children. The licensee will submit the documents to the LPA no later than 08/21/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Cynthia Gray
LICENSING EVALUATOR NAME:Michelle Hood
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
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