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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628689
Report Date: 08/24/2023
Date Signed: 08/24/2023 01:06:17 PM

Document Has Been Signed on 08/24/2023 01:06 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:JAMA, SAFIYO & FARAH, ABDI FAMILY CHILD CAREFACILITY NUMBER:
376628689
ADMINISTRATOR:S.JAMA & A.FARAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 254-8654
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
08/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:56 AM
MET WITH:Safiyo JamaTIME COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to follow-up on an incident that occurred on 08/01/2023. LPA advised Licensee Safiyo Jama of the meeting’s purpose and was granted facility entry. Licensee Jama provided LPA with a facility tour. There were four (4) children with both Licensees and one (1) helper.

A child sustained an injury and required medical examination on 08/01/2023. The incident was self reported by the facility and a written report was received in the Licensing office within the required reporting period. There were 4 children with the Licensee Jama during the incident. On 08/01/2023, at about 5:30 PM, children played outside in the facility’s front yard with the Licensee Jama. A neighbor was in the process of slowly backing his car out of the shared side driveway. The neighbor and Licensee Jama alerted the children of this action. Child 1 (C1) initially complied but then ran to the car, scraping her left ankle against it. (See LIC 811 Confidential Names). The Licensee contacted the parent. Paramedics were contacted, who medically cleared the child. The parent brought C1 to a hospital. Medical staff examined the child to have no injuries other than a bruise on their left ankle. Daycare parents denied any concerns of absent supervision. Licensee Abdi Farah states he was not present during the incident. Licensee Jama, S1 and the neighbor also report that the children were supervised by the Licensee during the incident. Children were unable to provide a statement due to their developmental levels. LPA inspected the facility’s front yard and observed no apparent hazards accessible to children. No deficiencies cited.

A notice of site visit was given to [applicant, licensee, or facility representative] and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Licensee/Appeal Rights (LIC 9058) was provided to Licensee Jama. Exit interview conducted and report was reviewed with the [applicant, licensee, or facility representative Licensee Safiyo Jama.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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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