376629200-9-27-2021-20-CC-JARL-C79QEQ-20210927120643

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629200
Report Date: 09/27/2021
Date Signed: 09/27/2021 12:07:00 PM

Document Has Been Signed on 09/27/2021 12:07 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:	ALI, HABIBO FAMILY CHILD CARE		FACILITY NUMBER:	376629200
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/27/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Habibo Ali		TIME COMPLETED:	10:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 27, 2021 at 9:45 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a pre-licensing change of location inspection with Licensee Habibo Ali. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present in the home was only the Licensee. This two (2) bedroom, two (2) bathroom apartment unit was toured and inspected; within the unit are two (2) floors. The daycare operational schedule will be every day from about 5:30 AM to 2:00 AM. Licensee will use the following areas for childcare: living room and the downstairs bathroom. The off limits areas include the kitchen and the unit’s top floor. The kitchen and stairs to the second floor are made inaccessible to day care children by use of safety gates. There are no bodies of water observed during time of visit. The fire extinguisher is rated 2A 10B: C and located in kitchen. The smoke and carbon monoxide detector meets requirements and are operational. Poisons, detergents, cleaning compounds and medicines are in an upstairs room; stairs to the upstairs room are barred with a safety gate. Children’s toys and play equipment are available. The Licensee has a working telephone/cell phone. The Licensee agreed to notify licensing should her telephone number or email address ever change. The Licensee indicated there are no firearms or other weapons in the home. The Licensee intends to conduct outdoor activities in the neighborhood park. The Licensee acknowledges continuous, visual supervision shall be given whenever children are engaged in outdoor activities. The Licensee will transport the children in their own vehicle. The Licensee shall transport children in rear seats in appropriate child passenger restraint systems which meet applicable federal motor

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

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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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: ALI, HABIBO FAMILY CHILD CARE	FACILITY NUMBER: 376629200
	VISIT DATE: 09/27/2021

NARRATIVE

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vehicle safety standards. The Licensee acknowledges children shall never be left unattended in the daycare vehicle. The Licensee further confirms maintenance of the daycare vehicle shall be upheld to ensure safety.

The Licensee maintains documentation of proof of control of property for review by the Department. The Licensee is scheduled to complete the lead poisoning prevention course on 09/29/2021. Pediatric CPR and First Aid certifications expire in September 2023. The Licensee and adult residents in the home have criminal record clearances and/or exemptions on file. The Licensee was advised that any new/additional adults must be cleared prior to working or residing in the home. Any minor upon their 18th birthday must be fingerprinted within 30 days. LPA advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change. The Licensee states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes.

The Licensee does not plan on providing Incidental Medical Services (IMS) to clients at this time. 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

Licensee was reminded that the following items are prohibited during day care operating hours: walkers, exersaucers, jumpers, inclined sleepers and bouncy seats. Corporal punishment and smoking are not allowed in the day care.

LPA discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home. Landlord consent is on file.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

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: ALI, HABIBO FAMILY CHILD CARE	FACILITY NUMBER: 376629200
	VISIT DATE: 09/27/2021

NARRATIVE

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The Licensee agrees to comply with all regulations and laws governing family childcare homes. The Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. The Licensing Duty Line was provided: (619) 767-2248. The Southern California Child Care Advocate (SCCCA) information was provided. Licensee is already enrolled in the SCCA email list through the CCLD website, thus she receives updated regulation information. Advocate information was provided: (916) 654-1541 or childcareadvocatesprogram@dss.ca.gov.

Licensee still needs to complete the lead poisoning prevention course, which is scheduled for 09/29/2021. A provisional license will be issued effective today 09/27/2021. A permanent license will be issued upon the Department’s receipt of Licensee’s lead poisoning prevention course completion certificate. Licensee understands that should the lead poisoning prevention course certificate is not received by 10/29/2021, her provisional license will immediately expire.

An exit interview was conducted with the Licensee. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to the Licensee and their signature on this form confirms receipt of these rights.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

LIC809 (FAS) - (06/04)

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