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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627173
Report Date: 08/14/2024
Date Signed: 08/14/2024 01:44:14 PM

Document Has Been Signed on 08/14/2024 01:44 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:NOR, SAHRO & IBRAHIM, KALID FAMILY CHILD CAREFACILITY NUMBER:
376627173
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 11CENSUS: 2DATE:
08/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Nor, SahroTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On August 14, 2024, at 9:45 am, Licensing Program Analyst (LPA) Angela Nguyen and Oscar Picazo and Licensing Program Manager (LPM) Tulam Vu conducted an unannounced Annual/ Random inspection. LPAs and LPM met with Licensee, Nor Sahro and was granted access to the facility. Licensee was holding a baby and 1 additional child under 2 years of age was present during the inspection. Licensee submitted an application for an increase in capacity for 14 children on 4/17/2024. LPA disclosed the purpose of the inspection and was granted a tour into the facility by the Licensee. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This two story, 4 bedroom, 2.5 bath home was toured and inspected. The hours of operation are Monday through Friday from 6 a.m. – 10p.m.

On July 22, 2024, a fire clearance was granted for a large license (14 children). Licensee will use the following areas for childcare: living room, family room and bathroom located near the kitchen and backyard. Off limits areas: entire second floor including 4 bedrooms and 2 bathrooms, garage and kitchen. They are made inaccessible to day care children using a child proof gate barricading the bottom of the stairs and separating the day care areas from the kitchen and a lock on the garage door however, during the inspection the gates were open. Licensee does not have area in facility for outdoor play. Licensee stated she will adjust small enclosed patio area for outdoor play. Licensee stated it is currently an off-limits area but she will remove debris and adjust the fencing to make it an outdoor play area.

The fireplace is gas and has a screened safety door. Licensee states that she does not use the fireplace. LPA did not observe any bodies of water during time of inspection. The fire extinguisher is rated 2A-10B:C and is located on the wall in between the kitchen and living room. Smoke and carbon monoxide detectors meet requirements and are operational. LPA observed scrubbing bubbles cleaner, Lysol wipes, Raid and mirror cleaner in the downstairs bathroom, kitchen and living room in day care areas.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Angela Nguyen
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.

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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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: NOR, SAHRO & IBRAHIM, KALID FAMILY CHILD CARE
FACILITY NUMBER: 376627173
VISIT DATE: 08/14/2024
NARRATIVE
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 Licensee states she will make poisons, detergents, cleaning compound in day care areas inaccessible to children. Children’s toys and play equipment are available. The Licensee has a working telephone/cell phone. Licensee indicated there are no firearms or other weapons in the home.

Licensee maintains documentation of proof of control of property for review by the Department. Co Licensee Kalid Ibrahim has a valid Mandated Reporter AB1207 training certification that expires on 01/2026. Licensee has completed the Preventative Health Training. Both licensee has completed Pediatric CPR and First Aid certifications that expire on 11/2024. LPA advised licensee that Pediatric CRP and First aid and Mandated reporter expire every 2 years.

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.



LPA advised that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed change. Licensee states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family child care homes.

Licensee is currently taking care of 2 infants and there are no crib or play yard for children at this time. LPA discussed cribs or play yards are free from all loose articles and objects. Licensee shall physically check on sleeping infants up to 24 months of age every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227] shall be maintained for each infant up to 12 months of age. Licensee places infants up to 12 months of age on their backs for sleeping. 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.

A sample of children’s records were reviewed including children roster, emergency disaster log, co licensee requirements, forms and records.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Angela Nguyen
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
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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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: NOR, SAHRO & IBRAHIM, KALID FAMILY CHILD CARE
FACILITY NUMBER: 376627173
VISIT DATE: 08/14/2024
NARRATIVE
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Licensee does not plan on providing Incidental Medical Services (IMS) to clients at this time. 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 reviewed with Licensee and informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care.
Please visit the Guardian web page and set-up your Guardian account. https://cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. If you have any questions regarding Guardian, please contact CDSS at email: guardian@dss.ca.gov.

Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.
Southern California Child Care Advocate information was provided, and Licensee was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The maximum capacity for a large family child care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there are no Qualified Assistants present, the capacity reverts to the requirements for a Small Family Child Care. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

All deficiencies shall be corrected prior to approval for an increase in capacity. (See LIC 809D)

An exit interview was conducted and report was reviewed with the Applicant, Sahro Nor.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Angela Nguyen
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
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Document Has Been Signed on 08/14/2024 01:44 PM - It Cannot Be Edited


Created By: Angela Nguyen On 08/14/2024 at 11:58 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: NOR, SAHRO & IBRAHIM, KALID FAMILY CHILD CARE
FACILITY NUMBER: 376627173

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above by not barricading the bottom of the staircase and off limits kitchen with 2 children under 2 years of age in care 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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Licensee states she will fix the barricade to separate the kitchen and at the bottom of the staircase within 24 hours and send pictures to LPA via email.
Type A
Section Cited
CCR
102425(a)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above by not providing a play yard or play pin for 2 children under the age of 2 in care 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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Licensee stated she will purchase 2 play yards within 24 hours for the two infants in care and send proof to LPA via email.
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:Tulam Vu
LICENSING EVALUATOR NAME:Angela Nguyen
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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Document Has Been Signed on 08/14/2024 01:44 PM - It Cannot Be Edited


Created By: Angela Nguyen On 08/14/2024 at 11:58 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: NOR, SAHRO & IBRAHIM, KALID FAMILY CHILD CARE
FACILITY NUMBER: 376627173

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above by having scrubbing bubbles, raid, lysol wipes and mirror cleaner in day care areas with infants present which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/16/2024
Plan of Correction
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Licensee moved a few of the hazardous items during the inspection. She stated that she will move the rest of the detergents and cleaners and attach new latches on cabinets and provide pictures to LPA via email.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review the licensee did not comply with the section cited above by not having sleep logs for 2 infant in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2024
Plan of Correction
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Licensee states she will start a sleep log for 2 infants in care within 24 hours and send a sample of a sleep log to LPA via email.
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:Tulam Vu
LICENSING EVALUATOR NAME:Angela Nguyen
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


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Document Has Been Signed on 08/14/2024 01:44 PM - It Cannot Be Edited


Created By: Angela Nguyen On 08/14/2024 at 11:58 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: NOR, SAHRO & IBRAHIM, KALID FAMILY CHILD CARE
FACILITY NUMBER: 376627173

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above by not having immunization records for 5 children files reviewed at inspection 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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Licensee stated she will obtain immunizations from parents and complete the immunuzation records by next week and send proof to LPA via email.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review the licensee did not comply with the section cited above in not having an infant sleep plan for 2 infants in care 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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Licensee states she will give the forms to the parents annd assist them to fill out the forms and send proof to LPA via email.
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:Tulam Vu
LICENSING EVALUATOR NAME:Angela Nguyen
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: 6 of 8
Document Has Been Signed on 08/14/2024 01:44 PM - It Cannot Be Edited


Created By: Angela Nguyen On 08/14/2024 at 11:58 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: NOR, SAHRO & IBRAHIM, KALID FAMILY CHILD CARE
FACILITY NUMBER: 376627173

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review the licensee did not comply with the section cited above in by completeing the infant sleep plan for one 1 infant under 12 months 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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Licensee states she will provide form to parent today 8/14 to fill out the sleep plan and provide proof to LPA via email.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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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:Tulam Vu
LICENSING EVALUATOR NAME:Angela Nguyen
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


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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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: NOR, SAHRO & IBRAHIM, KALID FAMILY CHILD CARE
FACILITY NUMBER: 376627173
VISIT DATE: 08/14/2024
NARRATIVE
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LPA informed Licensee to provide a copy of this licensing report dated (8/14/2024) 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. LPA provided Licensee LIC 9224 form.

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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Angela Nguyen
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)
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