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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628619
Report Date: 01/17/2024
Date Signed: 01/17/2024 04:25:56 PM

Document Has Been Signed on 01/17/2024 04:25 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:QAMBI, SAHRA & ADEN, MOHAMUD FAMILY CHILD CAREFACILITY NUMBER:
376628619
ADMINISTRATOR:MOHAMUD A. & SAHRA Q.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 817-1338
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
01/17/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Sahra Qambi & Mohamud AdenTIME COMPLETED:
04:30 PM
NARRATIVE
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On January 17, 2024, at 12:40PM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the co-licensees, Sahra Qambi and Mohamud Aden. LPA disclosed the purpose of the inspection and was granted entry into the facility. Six (6) children and Ms. Qambi and Ms. Aden were present in the facility during this inspection. Cleared and associated helper, Lucky Egal, was initially present at analyst's original entry into the facility but left after the co-licensees arrived and analyst continued the visit with both of them present.

This facility is a two floor, four bedroom, three bathroom town home. Licensees accompanied LPA inside of the facility during this inspection. The following areas used for child care are: the kitchen, the living room, the bedroom (as the primary day care room) and the day care bathroom all located on the first floor of the home. Off limits areas are the entire second floor of the home and the garage. The second floor of the home is inaccessible through use of a child safety gate that is installed at the entrance at the bottom of the home staircase while the garage is made off limits with a door knob cover that is installed on it's door handle.

The fire extinguisher and combination smoke 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 side yard that the licensees do not use for the day care. They instead take children to a local park for outdoor activity whenever necessary. 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 03/19/24 for licensee Qambi and 08/02/24 for licensee Aden. Licensees have required immunizations. Licensee Qambi is exempt from Mandated Reporter Training as English is not her primary language. Facility roster is maintained and was reviewed.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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 01/17/2024 04:25 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 01/17/2024 at 03:08 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: QAMBI, SAHRA & ADEN, MOHAMUD FAMILY CHILD CARE
FACILITY NUMBER: 376628619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 record review, the licensees did not comply with the section cited above as they did not have copies of their sleep logs for the current three infants they have enrolled in the facility which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 01/29/2024
Plan of Correction
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Licensees state they have been maintaining sleep logs for their infants in care but do not have their files currently available for review. Licensees state they will provide analyst with sleep logs for the following week of 01/22/24-01/26/24 for two infants of their choice and send them to analyst by 01/29/24 to complete the correction.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

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 they had no records available for review of the children in care today which poses/posed a potential health, safety or personal rights risk to children in care
POC Due Date: 01/29/2024
Plan of Correction
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Licensees stated that the childrens records were unavailable as they were being transported to various parents to get updated but will send analyst copies of the updated files for three out of the six children whose records were reviewed today to analyst by 01/29/24 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: 01/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024


LIC809 (FAS) - (06/04)
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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: QAMBI, SAHRA & ADEN, MOHAMUD FAMILY CHILD CARE
FACILITY NUMBER: 376628619
VISIT DATE: 01/17/2024
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The last fire and disaster drills were conducted and documented on 06/08/23. 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 physically checks on sleeping infants every 15 minutes but was not able to provide a copy of their Safe Sleep Log for analyst to review during today's visit. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age whenever they are enrolled at the facility. 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.

Two 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 co-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.

LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC809 (FAS) - (06/04)
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