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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626273
Report Date: 09/27/2022
Date Signed: 09/27/2022 09:54:15 AM

Document Has Been Signed on 09/27/2022 09:54 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:HUSSAIN, SHUMYLA FAMILY CHILD CAREFACILITY NUMBER:
376626273
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 2DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Shumyla HussainTIME COMPLETED:
10:10 AM
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On 09/27/22 at 8:15am Licensing Program Analyst (LPA) Selina Siao arrived at the facility to conduct an unannounced annual and capacity increase inspection. Fire clearance was granted on 09/20/2022 for a large license. LPA was granted entry by Licensee, Shumyla Hussain. Upon arrival,licensee was at the home with one day care infant and another day care child was drop off during the inspection. The two story home was toured and inspected to ensure an environment safe for the care and supervision of children. The facility is operating within the licensed capacity and appropriate ratios. The Licensee is present in the home and has ensured that children in care are supervised at this time. When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include all of downstairs includes the playroom, bathroom, extra room for (infant napping only), living room, dining room, family room and kitchen. Off limits areas include: garage and the entire upstairs area. These areas are inaccessible through use of safety gate at the bottom of the stairs and doorknob cover. There is a working phone at the facility. The fire extinguisher size 3A40BC, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children. Inaccessibility of hazards must be constantly reassessed depending on the children in care. There is a glass door with safety latch at the fireplace.

Licensee and her husband owns the home. Facility has required posting posted at the home. Licensee's EMSA approved pediatric CPR and First Aid Card are current due to expire in Jan/2024. Licensee meets immunization requirements. Mandated Reporter training was taken on 08/07/2022. Licensee last conducted a fire drill with the children on 08/01/2022. A copy of the facility roster was obtained today.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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: HUSSAIN, SHUMYLA FAMILY CHILD CARE
FACILITY NUMBER: 376626273
VISIT DATE: 09/27/2022
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There are no bodies of water. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations. Safe and age appropriate toys and equipment are present at the home. Back yard is fenced and free of hazards.

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.

The inspection consisted of reviews of the following domains: Physical Plant, Care and Supervision, Facility Administration, Records, Staffing Ratio and Capacity, and Personal Rights.

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
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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: HUSSAIN, SHUMYLA FAMILY CHILD CARE
FACILITY NUMBER: 376626273
VISIT DATE: 09/27/2022
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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.

Access to forms & Regulations for Family Child Care are online at www.ccld.ca.gov. Please note it is you Responsibility to know the regulations for anyone providing care. The Duty Officer is available to answer questions Monday – Friday at (619) 767-2248 for any Unusual Incident Reporting.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

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 to avoid civil penalties associated with this requirement; 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.

Exit interview conducted and report was reviewed with the licensee, Shumyla Hussain. A large license will be granted effective today. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
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