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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628434
Report Date: 04/21/2025
Date Signed: 04/21/2025 12:59:32 PM

Document Has Been Signed on 04/21/2025 12:59 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:MOHAMED, LUL & ELMI, MARYAMO FAMILY CHILD CAREFACILITY NUMBER:
376628434
ADMINISTRATOR/
DIRECTOR:		LUL MOHAMED & MARYAMO ELMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 908-0838
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 3DATE:
04/21/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Lul MohamedTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On April 21, 2025, at 10:10AM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the co-licensees, Lul Mohamed and Maryamo Elmi. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensees. The co-licensees and three (3) day care children were present in the facility during this inspection. Licensees' relative and and owner of his own facility, Abdullah Farah, was visiting the facility and left before analyst began his inspection. This facility is a one floor, three bedroom, two bathroom house. Licensees 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 first home bedroom (as a napping room) and the day care bathroom. Off limits areas are the two back home bedrooms and the inclusive master bath and are inaccessible through use of locking door knobs on the respective bedroom entrance doors. Licensees understand that during day care hours the off limits room must always be closed and locked to prevent children from accessing them.

The fire extinguisher and combination smoke and carbon monoxide detector met requirements. Most hazardous items were inaccessible to children. The licensees have toys, play equipment and materials available. The home has a fenced backyard that the licensees do not use for day care as it has terraced planters and is a concrete yard. The yard is made of limits with a sliding screen door and locking back door. The licensees instead use the front yard for outdoor activities but as it is open and is on the same property as a second, separately addressed rental home and leads into the not for use back yard, they understand that direct supervision must be provided at all times the children are playing there.

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.
NAME OF LICENSING PROGRAM MANAGER: Jason Garay
NAME OF LICENSING PROGRAM ANALYST: Luigi Gargaro
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 04/21/2025 12:59 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 04/21/2025 at 11:38 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: MOHAMED, LUL & ELMI, MARYAMO FAMILY CHILD CARE
FACILITY NUMBER: 376628434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025

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 analyst observation, the licensee did not comply with the section cited above as medications such aspirin and other pain relievers and scissors were found in an unlatched kitchen drawer which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 04/21/2025
Plan of Correction
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The deficiency was corrected when licensee moved pain relievers and scissors to a higher out of reach cabinet above the kitchen sink where other pain relievers are kept. Licensees understand that all hazardous items must continue to be kept in areas that are out of reach of children or have some type of latch or other security device on their handles to keep children from accessing them. Violation cited as a Type B violation as all medications appeared to be secured and children were in other for use areas of day care and not in kitchen.
Type B
Section Cited
CCR
102417(g)(9)(A)
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensees did not comply with the section cited above as they did last showed fire and earthquake dirlls conducted on 06/08/23 and 01/07/23 , respectively, which poses/posed a potential health, safety or personal rights risk to children in care
POC Due Date: 05/05/2025
Plan of Correction
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Licensees were provided a blank drill log and stated they will conduct both a fire and earthquake drill, document them and then send analyst a copy of the documented drills by 05/05/25 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.
Jason Garay
NAME OF LICENSING PROGRAM MANAGER:
Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/21/2025 12:59 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 04/21/2025 at 11:38 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: MOHAMED, LUL & ELMI, MARYAMO FAMILY CHILD CARE
FACILITY NUMBER: 376628434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025

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 licensees did not comply with the section cited above as a pillow was in the playpen in which child #1 naps which poses/posed a potential health, safety or personal rights risk to infants in care.
POC Due Date: 04/21/2025
Plan of Correction
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Licensee removed the pillow during today's visit to correct the deficiency and understands that there should never be any objects found in any infant napping equipment moving forward.
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, the licensees did not comply with the section cited above as they are not keeping sleep logs for the infant they have in care which poses/posed a potential health, safety or personal rights risk to infants in care.
POC Due Date: 05/05/2025
Plan of Correction
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Licensee was provided a blank copy of a sample safe sleep log and states will begin maintaining sleep records for the only infant they have in care, child #1. Licensee states the documentation will begin tomorrow and continue going forward but she will provide analyst with a sample record period from 04/22/25 to 05/02/25 and submit the log documentation to him by 05/05/25 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.
Jason Garay
NAME OF LICENSING PROGRAM MANAGER:
Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2025


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 04/21/2025 12:59 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 04/21/2025 at 11:38 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: MOHAMED, LUL & ELMI, MARYAMO FAMILY CHILD CARE
FACILITY NUMBER: 376628434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst observation, the licensees did not comply with the section cited above as the door to the napping bedroom was closed when the child was sleeping there which poses/posed a potential health, safety or personal rights risk to infants in care.
POC Due Date: 04/21/2025
Plan of Correction
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Licensees understand from this point going forward whenever an infant is napping in another room where the provider is not stationed, the door must remain open at all times so that the provider may be aware of the infant's condition.
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 analyst record review, the licensees did not comply with the section cited above as the two sibling children in care today did not have any records which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 05/05/2025
Plan of Correction
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Licensee states she will have the parent complete a records packet for the two siblings and submit a copy of the completed records to analyst by 05/05/25 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.
Jason Garay
NAME OF LICENSING PROGRAM MANAGER:
Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2025


LIC809 (FAS) - (06/04)
Page: 5 of 6
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: MOHAMED, LUL & ELMI, MARYAMO FAMILY CHILD CARE
FACILITY NUMBER: 376628434
VISIT DATE: 04/21/2025
NARRATIVE
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Licensee Mohamed's and Elmi's First Aid and CPR certifications expire on May of 2025. Licensees have the required immunizations. Licensee Elmi completed Mandated Reporter Training on 07/06/23. Licensee Mohamed is exempt from taking the training as English is not her primary language. The licensees' roster was reviewed and appeared in order. The last fire and disaster drills were conducted on 06/08/23 and 01/07/23, respectively. 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 were not free from all loose articles and objects. The providers do not physically checks on sleeping infants every 15 minutes as required. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is 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. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov

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.s

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

A notice of site visit was provided by the LPA and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Jason Garay
NAME OF LICENSING PROGRAM ANALYST: Luigi Gargaro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025
LIC809 (FAS) - (06/04)
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