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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626656
Report Date: 05/03/2023
Date Signed: 05/16/2023 01:51:38 PM

Document Has Been Signed on 05/16/2023 01:51 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:AHMED, HAWA FAMILY CHILD CAREFACILITY NUMBER:
376626656
ADMINISTRATOR:HAWA AHMEDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 345-7637
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Hawa AhmedTIME COMPLETED:
03:30 PM
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On 5/3/2023 @ 11:55AM, LPA Nancy Diaz conducted an unannounced inspection. Present in the home were Abdirashid and Asha Ali (licensee's adult children). Licensee's son, Abdirashid helped in translating this inspection in Somali. They stated that Hawa Ahmed was with their grandma due to a family emergency. Mr. Ali stated that Mrs. Ahmed should arrive soon. Mrs. Ahmed arrived at 1:00PM with 2 daycare children. LPA disclosed the purpose of the inspection and was granted facility entry by Abdirashid Ali. A tour of the home was conducted with Mr. Ali. Observed present today were two children. The following areas are accessible to children living room, dining, family room and hallway bathroom. Licensee takes the children to Sandburg park for outdoor activities. Facility operates 7 days a week/ 24 hours/day. The licensee was present in the home to ensure that all children are supervised at all times. Facility is within capacity and did not exceed the capacity specified on the license.

There were no bodies of water observed within the premises. Mrs. Ahmed stated that she does not maintain weapons in the home.

Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored appropriately and inaccessible to children. Fire extinguisher and smoke detectors meet State Fire Marshall standards. The carbon monoxide detector present in the home meet the standards established in Chapter 8 of Part 2, Division 12. Home is kept clean and orderly with heating and ventilation for safety and comfort. A barricade was observed at the bottom of the stairs. Licensee provide safe toys, play equipment and materials. The home maintains a working telephone service.

There is a playpen for each infant who is unable to climb out of the play pen. The crib was observed to be free from all loose articles and objects. Bumper pads are not used. There are no objects hanging above or attached to the side of the crib. Infants are not swaddled while in care. Infants are supervised while they sleep. The provider check on sleeping infants every 15 minutes. Licensee did not maintain the required 15-minute nap log.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: AHMED, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376626656
VISIT DATE: 05/03/2023
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LPA discussed the safe sleep regulations with licensee 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 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.

Car seats are only used for transportation purposes and not used for sleeping. Infants are supervised while they sleep.

An isolation area has been designated for children who became ill during the day.

Children’s records were reviewed. Licensee maintains a copy of the emergency information card that contains all of the information specified by the regulation.

Staff records were reviewed. Licensee's mandated reporter training certificate have expired. Helpers Asha & Abdirashid Ali did not have a Mandated reporter training certificate. Licensee and helpers did not have a current CPR & First Aid certificates. Licensee was made aware that the mandated reporter training shall be renewed every 2 years.
Asha & Abdirashid did not have the required immunization record on file (Measles, Pertussis & Influenza). Licensee’s CPR and First aid has expired.
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: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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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: AHMED, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376626656
VISIT DATE: 05/03/2023
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Incidental Medical Services (IMS) policy was discussed. Mrs. Ahmed stated that she does not maintain medication for children. 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

TYPE A & B DEFICIENCIES WERE CITED. CIVIL PENALTY WAS ASSESSED.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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.

Exit interview conducted and report was reviewed with facility representative, Hawa Ahmed. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was provided and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/16/2023 01:51 PM - It Cannot Be Edited


Created By: Nancy Diaz On 05/11/2023 at 11:19 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: AHMED, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376626656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2023
Section Cited
CCR
102416.2

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(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).
This requirement is not met as evidenced by:
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Mrs. Hawa stated that she will have her helpers Asha & Abdirashid Ali complete the required Preventative Health course no later than 5/10/23. Copy of certificates must be submitted to the department no later than 5/10/23.
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee's helpers, Asha & Abdirashid Ali did not have proof of Preventative Health Course completion. This posed a potential health, safety or personal rights risk to persons 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:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


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Document Has Been Signed on 05/16/2023 01:51 PM - It Cannot Be Edited


Created By: Nancy Diaz On 05/11/2023 at 11:22 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: AHMED, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376626656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/04/2023
Section Cited
CCR
102370(d)(1)

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(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement was not met as evidenced by:
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Mrs. Ahmed stated that she will have son, Ismail Ali obtain livescan fingerprint no later than 5/4/2023.
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Based on interview & record review, the licensee did not comply with the section cited above. Licensee's son Ismail Ali turned 18 on January 6, 2023. This poses an immediate health, safety or personal rights risk to persons 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:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/16/2023 01:51 PM - It Cannot Be Edited


Created By: Nancy Diaz On 05/11/2023 at 11:26 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: AHMED, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376626656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2023
Section Cited
HSC
1596.8662(b)(1)

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(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant...
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Licensee stated that she and her 2 helpers will complete the Mandated Reporter Training course and submit them to the department no later than 5/10/23.
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee's Mandated reporter training have expired. Her two helpers - Asha & Abdirashid Ali has not completed a course in Mandated Reporter Training. This poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
05/10/2023
Section Cited
CCR102416(c)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
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Mrs. Hawa stated that she will have her 2 helpers, Asha & Abdirashid Ali complete the required Pediatric CPR & First Aid course no later than 5/10/23. A copy of certificates must be submitted to the department no later than 5/10/23.
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee and her 2 helpers, Asha & Abdirashid Ali did not have proof that they have completed Pediatric First Aid & CPR. This poses/posed a potential health, safety or personal rights risk to persons 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:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


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Document Has Been Signed on 05/16/2023 01:51 PM - It Cannot Be Edited


Created By: Nancy Diaz On 05/11/2023 at 11:32 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: AHMED, HAWA FAMILY CHILD CARE
FACILITY NUMBER: 376626656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2023
Section Cited
CCR
102417(g)(9)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department...

This requirement was not met as evidenced by:
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Mrs. Hawa stated that she will conduct a fire drill and document such drill no later than 5/10/2023. Mrs. Hawa shall send a copy of the fire drill log to the department no latet than 5/10/23.
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee has not conducted a fire drill since December 2021. This posed a potential health, safety or personal rights risk to persons in care.
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Type B
05/10/2023
Section Cited
CCR102425(j)(2)

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The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

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Mrs. Hawa stated that she has documented the infant's 15-minute check but was unable to locate such documents. Mrs. Hawa was provided a sample copy of the 15-minute nap log by LPA. She will document a week's worth of napping for 2 infants she has in care and submit them to the department no later than 5/11/23.
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Based on interview and record review, the licensee did not comply with the section cited above. Licensee did not maintain a log to document the infant's 15-minute nap check. This poses a potential health, safety or personal rights risk to persons 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:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


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