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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629597
Report Date: 03/28/2023
Date Signed: 03/28/2023 11:57:02 AM

Document Has Been Signed on 03/28/2023 11:57 AM - 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:NDIKUMANA, ESTELLA & WARSAME, ABDIRISAK FCCFACILITY NUMBER:
376629597
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/28/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Estella NdikumanaTIME COMPLETED:
12:10 PM
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On 03/28/23 at 10:10AM, LPA, Luigi Gargaro, conducted an announced prelicensing inspection for a relocation with co-applicant Estella Ndikumana to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. 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. The co-applicant was asked whether she had any bodies of water or weapons in the home and she replied no. CPR and First Aid expire on November of 2024 for Ms. Ndikumana. 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. Applicants rent the home and provided proof of control of property during today's visit.

Applicants will be using the following rooms for childcare: the kitchen, the living room, the first bedroom (bedroom #1) and the day care bathroom. Off limits are the remaining three home bedrooms and the second bathroom. Bedrooms #2 and #3 are made off limits with locking door handles and applicant understands they are to be closed and locked whenever day care children are present. Bedroom #4 (the master bedroom) and the second bathroom are located to the left of the home kitchen and are inaccessible with the use of a locking entrance door in the hallway that leads to those rooms as well as a laundry area. The applicant has a wall heating unit that Ms. Ndikumana attests will not be used during day care hours and, if it is ever turned on for use, will have to have a safety gate or other security device installed to make it inaccessible.

The applicants have sufficient day care equipment available. The home has a fenced backyard and front yard available for outdoor activities. Due to the the yards being fully open to each other with no gating to separate them, applicants understand that they are to provide direct supervision in the outdoor areas at all times to ensure that the children remain in the yard in which they are playing at any given time.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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: NDIKUMANA, ESTELLA & WARSAME, ABDIRISAK FCC
FACILITY NUMBER: 376629597
VISIT DATE: 03/28/2023
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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 applicant discussed California Megan's Law and he provided applicant 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.
Applicants were reminded of requirements for children’s records, child abuse and unusual incident reporting, immunizations, adults living or working in the home and associated 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.

A license for 8 will be issued at this new location after the following corrections: lease agreement does not show Mr. Warsame as a controlling party on the lease but only as a resident in the home. A revised lease agreement is required showing him as one of the leaseholders or an updated application removing him as a co-licensee in order to have a license granted under either both or one of their names. Applicants have until 04/07/23 to provide analyst with an updated lease agreement or application or potentially have their application withdrawn or denied if no submission is received by that time.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
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