376630001-6-20-2024-20-CC-JARL-D6EMEN-20240620093259

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376630001
Report Date: 06/20/2024
Date Signed: 06/20/2024 09:33:32 AM

Document Has Been Signed on 06/20/2024 09:33 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:	JAMA, SHUKRI FAMILY CHILD CARE		FACILITY NUMBER:	376630001
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	06/20/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	07:30 AM
MET WITH:	Shukri Jama		TIME VISIT/ INSPECTION COMPLETED:	09:15 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 June 20^th, 2024, at 7:30 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a pre-licensing relocation inspection with Applicant Shukri Jama. 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 the Applicant, Maryan Ahmed (background cleared adult daughter) and (1) related minor over 10 years. This three (3) bedroom, two (2) bathroom house was toured and inspected. The daycare operational schedule will be everyday 12 AM – 12 PM. The Applicant shall submit an updated application to the Licensing Department should the daycare operational schedule change. The Applicant acknowledges that they will need to notify the Department of any changes to the childcare areas and obtain departmental approval before use of any new childcare areas not previously licensed. Applicant will use the following areas for childcare: the living room, dining room and one (1) bathroom. The off-limits areas include the kitchen, garage, remaining bathroom, and the bedrooms. The kitchen is barricaded with a child safety gate. Access into the remaining bathroom is through its adjoining bedroom; access into this bedroom is through the kitchen, which is barricaded with a child safety gate. Doorknobs to the remaining bedrooms are covered with child safety doorknob covers. The garage is made inaccessible by use of a latch lock at the top of its door. There are no bodies of water observed during time of visit. The fire extinguisher is in the kitchen. The smoke/carbon monoxide detector meets requirements and is operational. Poisons, detergents, cleaning compounds and medications are secured inaccessible to children in care by placement in the under-sink kitchen cabinet and a high kitchen cabinet; access into the kitchen is made inaccessible by use of the safety gate. Children’s toys and play equipment are available. The Applicant has a working telephone/cell phone. The Applicant shall notify licensing should their telephone number or email address ever change. The Applicant provided a written statement confirming there are no firearms or other weapons in the home. The applicant also provided a written statement confirming no animals/pets cohabitate the home.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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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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: JAMA, SHUKRI FAMILY CHILD CARE	FACILITY NUMBER: 376630001
	VISIT DATE: 06/20/2024

NARRATIVE

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The Applicant intends to conduct outdoor activities in the neighborhood park and fenced backyard. The Applicant acknowledges continuous, visual supervision shall be given whenever children are engaged in outdoor activities. The Applicant may transport the children in their own vehicle if legally licensed and the vehicle lawfully insured. The Applicant shall transport children in rear seats in appropriate child passenger restraint systems which meet applicable federal motor vehicle safety standards. The Applicant acknowledges that car seats shall only be used for transportation purposes and shall not be used for sleeping. The Applicant acknowledges children shall never be left unattended in the daycare vehicle. The Applicant states they will adhere to the daycare vehicle’s safety maintenance schedule and promptly address any vehicular issues to ensure children’s safety.

Applicant has completed the preventative health and lead poisoning prevention courses. The Mandated Reporter training was completed on 02/12/2023. Applicant acknowledges they will need to repeat the Mandated Reporter training and obtain its training completion certificate once every two (2) years. Pediatric CPR and First Aid certifications expire on in April 2025. Applicant acknowledges that they will need to repeat the pediatric CPR and First Aide certifications before April 2025. Immunization records per SB792 were reviewed and comply. Applicant acknowledges they will either receive a yearly influenza vaccination or have a yearly written statement declining receipt of the annual influenza vaccination. Applicant shall maintain written documentation of the yearly influenza vaccination or yearly written stating declining the annual influenza vaccination in the facility file available for Departmental review.

Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. The Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted within 30 days.

The Applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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: JAMA, SHUKRI FAMILY CHILD CARE	FACILITY NUMBER: 376630001
	VISIT DATE: 06/20/2024

NARRATIVE

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Applicant and LPA reviewed the ratio/capacity worksheet together. LPA discussed the maximum capacity for a small family childcare 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.

The Applicant acknowledges that licensees shall be present in the home and shall ensure that children in care are supervised at all times. Applicant also acknowledged that when circumstances require a licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult, who is background cleared and associated to the license, to care for and supervise the children during their absence. Applicant acknowledged that temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

During the interview, the Applicant, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. On this date, 06/11/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To provide overnight care, the applicant shall remain awake whenever children are awake or asleep. The door to the room where the applicant is sleeping as well as the door to the room where the children in care are sleeping

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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: JAMA, SHUKRI FAMILY CHILD CARE	FACILITY NUMBER: 376630001
	VISIT DATE: 06/20/2024

NARRATIVE

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shall remain open. If the sleeping arrangements are not situated in such a way that the applicant can be assured of hearing a child in care wake up, a digital video and audio monitoring device shall be used; the monitoring device shall be maintained in good working order at all times. Clean bedding and nightclothes shall be available to children in care. To provide overnight care for infants, the provider shall the follow requirements specified in CCR 102425 Infant Safe Sleep. The monitoring device may be used in place of physically checking the infant every 15 minutes if the infant is sleeping and the provider is going to sleep.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

LPA reviewed with Applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. The Applicant was also informed 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.

The Applicant states they are financially secure to operate a family childcare home for children. The Applicant agrees to comply with all regulations and laws governing family childcare homes.

Applicant was advised that an agent of the Licensing Department upon presentation of proper identification, may enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice. The Applicant shall permit the Department to inspect the family childcare home, and to privately interview children or adults, to determine compliance with or to prevent violations of family childcare laws or regulations. Applicant was advised that the Department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, if the Applicant refuses any agent of the licensing Department entry into the daycare or any part of the daycare.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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: JAMA, SHUKRI FAMILY CHILD CARE	FACILITY NUMBER: 376630001
	VISIT DATE: 06/20/2024

NARRATIVE

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LPA informed Applicant that the failure of a Licensee to pay all applicable and accrued fees and/or civil penalties shall constitute grounds of forfeiture of the daycare license.

Applicant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. LPA observed that applicant’s email address is enrolled into the Department’s email program update notification system.

No corrections are needed. A small license is issued effective today 06/20/2020. The Applicant requests to retrieve the new license from the licensing office when available. The applicant will be notified when the new license is available for retrieval from the licensing office. Exit interview conducted and report was reviewed with the Applicant Shukri Jama.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC809 (FAS) - (06/04)

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