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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629428
Report Date: 11/28/2023
Date Signed: 11/28/2023 03:54:46 PM

Document Has Been Signed on 11/28/2023 03:54 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:KASIM, SHAMI FAMILY CHILD CAREFACILITY NUMBER:
376629428
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/28/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Shami KasimTIME COMPLETED:
04:00 PM
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On 11/28/23 at 2:00PM, LPA, Luigi Gargaro, conducted an unannounced capacity increase visit with the applicant. The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke and carbon monoxide detectors meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Analyst inquired of the applicant about whether there were any bodies of water or weapons in the home and she replied no. 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. The home appears to be large enough to comfortably accommodate 14 children. Fire clearance was received on 11/14/23 from the San Diego Fire Department. First Aid and CPR certifications expire on October 2, 2024 for the applicant.

Applicant will be using the following rooms for childcare: the living room, the kitchen, the first bedroom located behind the kitchen and the bathroom located in that first bedroom. The kitchen has an installed safety gate at its entrance but as it is used as a pass through area to get to the for use bedroom, it will be considered a "for use" area in which child proofing requirements will always need to be maintained. Applicant can keep the gate closed at her discretion if she is cooking or needs to keep it that way for a temporary activity.

Analyst inspected the kitchen today and found it to be safely child proofed. The for use bedroom has a wall heating unit that applicant attests will not be used during day care and understands that if she does decide to operate it will install a safety gate around it or other security device to make it inaccessible to day care children.

The following areas will be off limits: the other three bedrooms and the second home bathroom. The rooms are made off limits with an entrance door off the living room that has a door knob cover on it that leads to that separate, self-contained portion of the home. The applicant has sufficient toys and equipment available.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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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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: KASIM, SHAMI FAMILY CHILD CARE
FACILITY NUMBER: 376629428
VISIT DATE: 11/28/2023
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Applicant has a fenced backyard that will not be used for the day care as it stores her personal items. The backyard is made off limits with two latching and locking side gates and contains an off limits locked storage shed. The only other entrances to the backyard are through a sliding patio door from the for use bedroom and a kitchen exit door. The bedroom exit is made off limits with a locking gate with a door knob cover on its handle while the kitchen door has a turn lock. Applicant will be instead using her gated front yard for outdoor activity.

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. LPA and licensee discussed California Megan's Law and he provided licensee with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov.

The following information was reviewed with the applicant: information on reporting requirements for suspected child abuse and unusual incidents, children’s records, immunizations, adults living or working in the home and related civil penalties, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care.

The home appears to be in sufficient compliance and as no corrections are needed, a license for 14 will be issued effective today. Analyst printed a copy of the Notice Of Site Visit today and had licensee place it in her facility notice area before he left the home.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
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