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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628601
Report Date: 10/06/2022
Date Signed: 10/06/2022 12:06:35 PM

Document Has Been Signed on 10/06/2022 12:06 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:FARAH, ASHO & ABDILLAHI SADIO FAMILY CHILD CAREFACILITY NUMBER:
376628601
ADMINISTRATOR:A. FARAH & S.ABDILLAHIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 642-6455
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Asho Farah and Sadio Abdillahi TIME COMPLETED:
10:30 AM
NARRATIVE
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On October 6th, 2022 at 10:05 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection because a deficiency was observed during a complaint inspection. LPA advised Licensee Asho Farah of the visit’s purpose and granted LPA facility entry. Present in the home were the Licensees.

LPA interviewed both Licensees. On 09/29/2022, the parent informed the Licensees that their child had unusual marks on their body, but Licensees stated they were unaware the child had any body marks and that the child did not sustain those marks while in care. Both Licensees stated that it was an unusual incident that any parent would approach them and inquire of the origin of a child's unusual body marks. Review of the Community Care Licensing (CCL) records reveals no incident report was filed with CCL regarding this incident. The Licensees stated this incident was not reported to the Department because they were unaware of this child’s marks until disclosed by the parent and that the child did not sustain those marks while in care.

Based on conducted interviews and a file review, it has been determined that the facility failed to report the aforementioned unusual incident to CCL. This deficiency is being cited per the California Code of Regulations, (Title 22, Division 6), and described on the attached LIC 809D.



A notice of site visit was given and must remain posted for 30 days. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to Licensees Asho Farah and Sadio Abdillahi. Exit interview conducted and report was reviewed with the licensee Asho Farah and Sadio Abdillahi.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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Document Has Been Signed on 10/06/2022 12:06 PM - It Cannot Be Edited


Created By: JoAnn R Legaspi On 10/06/2022 at 09:18 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: FARAH, ASHO & ABDILLAHI SADIO FAMILY CHILD CARE
FACILITY NUMBER: 376628601

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2022
Section Cited
CCR
102416.2(a)(3(C)

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Reporting Requirements: “ … The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm) …. Any unusual incident …” This requirement was not met as evidenced by:

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LPA provided Licensees with a hard copy of CCR 102416.2(a)(3)(C) and a blank LIC 624B form. Licensees agrees to call & speak with the CCL Duty Officer about the 09/28/2022 incident. The CCL Duty Officer's telephone number is (619)767-2248 no later than
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Licensees did not report the 09/28/2022 because they were unaware of the situation and that the child did not sustain the marks while in care. Based on Licensees' admissions & record review, licensees did not report the 09/28/2022 incident, which poses as a potential health & safety risk to children in care.


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10/10/2022. The Licensees will then provide LPA with the completed LIC 624B form no later than 10/10/2022.

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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:Tulam Vu
LICENSING EVALUATOR NAME:JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022


LIC809 (FAS) - (06/04)
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