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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627528
Report Date: 07/09/2024
Date Signed: 07/09/2024 03:41:35 PM

Document Has Been Signed on 07/09/2024 03:41 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:SHEIKH-MOHAMED, AYAN FAMILY CHILD CAREFACILITY NUMBER:
376627528
ADMINISTRATOR/
DIRECTOR:		AYAN SHEIKH-MOHAMEDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 564-1046
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ayan Sheikh-Mohamed and Amal HassanTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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On July 9, 2024, at 11:00 AM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the licensee, Ayan Sheikh-Mohamed and facility assistant Amal Hassan. LPA disclosed the purpose of the inspection and was granted entry into the facility by Ms. Sheikh-Mohamed. Nine (9) children and Ms. Sheikh-Mohamed was present by herself in the facility during this inspection. Ms. Hassan arrived at the facility after analyst began conducting his inspection. This facility is a one floor, three bedroom, two bathroom house. Licensee and assistant accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: the kitchen, the dining area, the living room, the day care play room, the first bedroom and the bathroom. Off limits areas are the second bedroom with inclusive bath and the garage. The bedroom is made off limits with a locking door handle. The garage is inaccessible through the use of a door lock and a dead bolt lock on its entry door as well as a highly placed latch and bolt. The home has a wall heating unit that the licensee attests is non-operable. Licensee understands, however, that if the unit is made to operate she must install a screen or other security device to make it inaccessible to children in care.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. The backyard is bisected by wooden fence and latching gate. The back portion of the yard is solely for the licensee's use and is off limits to the day care children. No bodies of water observed on the premises during the inspection. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

Licensee’s First Aid and CPR certifications expire on December 9, 2024 Licensee and assistant have required immunizations. Licensee and helper do not have current Mandated Reporter Training certifications. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted in 01/02/24.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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Document Has Been Signed on 07/09/2024 03:41 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 07/09/2024 at 01:25 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: SHEIKH-MOHAMED, AYAN FAMILY CHILD CARE
FACILITY NUMBER: 376627528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst observation, the licensee did not comply with the section cited above as when analyst walked into the day care bedroom child #2, an infant, had a blanket and pillow with him in his crib which poses/posed a potential health, safety or personal rights risk to infants in care.
POC Due Date: 07/09/2024
Plan of Correction
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Licensee stated that she is aware of the regulation that cribs cannot have any loose objects in them but that she just placed them in there as the child likes to have what the other children have. The objects were removed before the child started their nap and licensee was reminded that objects should not be placed in a crib at any time.
Type B
Section Cited
CCR
102425(j)(2)(B)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst interview and record review, the licensee did not comply with the section cited above as she has not been maintaining safe sleep logs for the infants she has in care, children #1 & #2, which poses/posed a potential health, safety or personal rights risk to infants in care.
POC Due Date: 07/15/2024
Plan of Correction
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Licensee was provided with a sample copy of a safe sleep log and states she will start maintaining one for each day infants are napping in the home from this point going forward. Licensee states she will send analyst a copy of the log for the period of 07/10/24-07/12/24 for both infants in care by 07/15/24 to complete the correction.
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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2024 03:41 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 07/09/2024 at 01:25 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: SHEIKH-MOHAMED, AYAN FAMILY CHILD CARE
FACILITY NUMBER: 376627528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(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 to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst record review, the licensee did not comply with the section cited above as both she and her assistant do not have current Mandated Reporter Training certifications which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 08/12/2024
Plan of Correction
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Licensee was provided with a flyer with information for the free on-line Mandated Reporter Training and states she and assistant will take and complete the training and send analyst copies of their completed certificates by 08/12/24 to complete the correction.
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 record review, the licensee did not comply with the section cited above in as children #1, #2, #5 and #6 were missing most current updates on different shots which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 08/12/2024
Plan of Correction
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Licensee states she will check with the parents of the children in question and obtain of a copy of their yellow shot cards from them to verify that the shots have been obtained and, if not, will have the parent obtain them and then document them and send copies of the updated blue shot cards to anlayst by 08/12/24 to complete the correction.
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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2024 03:41 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 07/09/2024 at 01:25 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: SHEIKH-MOHAMED, AYAN FAMILY CHILD CARE
FACILITY NUMBER: 376627528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 analyst record review, the licensee did not comply with the section cited above she did not have an Individual Infant Sleeping Plan for the infant in care she has under 12 months of age, child #1 which poses/posed a potential health, safety or personal rights risk to infants in care.
POC Due Date: 07/15/2024
Plan of Correction
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Analyst provided licensee with a blank LIC 9227 and licensee states she will have the parent complete it, put it in the child's file and then send analyst a copy by 07/15/24 to address the deficiency.
Type B
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst observation, the licensee did not comply with the section cited above as when he arrived at the facility the licensee was alone with nine children which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 07/09/2024
Plan of Correction
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Licensee stated that helper had gone out for milk but she called her back and assistant returned within 15-20 minutes after analyst's arrival. Licensee understands that whenever she has more than eight children she must have her helper present to meet the large license requirements. Violation was cited as a type B one as licensee was overcapacity by one child within the proper age groups with assistant returning in reasonable time frame.
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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


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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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SHEIKH-MOHAMED, AYAN FAMILY CHILD CARE
FACILITY NUMBER: 376627528
VISIT DATE: 07/09/2024
NARRATIVE
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There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider has not been physically checking on sleeping infants every 15 minutes or maintaining a safe sleep log as required. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is not maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

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.

Six type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

Licensee was provided a notice of site visit and was advised it must be posted in the facility notification area for 30 days.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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