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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376630001
Report Date: 02/11/2025
Date Signed: 02/11/2025 04:09:47 PM

Document Has Been Signed on 02/11/2025 04:09 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JAMA, SHUKRI FAMILY CHILD CAREFACILITY NUMBER:
376630001
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/11/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Shukri JamaTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On February 11, 2025, at 12:40p.m., Licensing Program Analyst (LPA), Jacqueline Macias conducted an unannounced Required Annual Inspection for the purpose of a capacity increase and met with Licensee, Shukri Jama. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Zero (0) daycare children were present in the facility during this inspection. The fire clearance for 14 children was granted/received on 10/02/2024.This facility is a one story, 3 bedroom, 2 bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: Living room/dining room, bathroom #2, and backyard. Off limits areas are bedroom #1, bedroom #2, bedroom #3, kitchen, bathroom #2, and garage and are inaccessible through use of door knob covers. Hours of operation are: Monday – Sunday, 6am to 5:00am (23) hours.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All Hazardous items were made inaccessible to children during the inspection. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities at time of inspection. Licensee shall supervise children during outside activities at all times. No bodies of water observed on the premises during the inspection. Licensee stated there are no weapons in the home. 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.

Licensee 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.

Cont on LIC 809C
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Jacqueline Macias
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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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Document Has Been Signed on 02/11/2025 04:09 PM - It Cannot Be Edited


Created By: Jacqueline Macias On 02/11/2025 at 03:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: JAMA, SHUKRI FAMILY CHILD CARE
FACILITY NUMBER: 376630001

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in not having the required Infant Sleeping Log on infant in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/20/2025
Plan of Correction
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Licensee stated that she will ensure to fill out an Infant Sleeping Log for every infant under the age of 24 months and will send copies of the week 2/12/25-2/19/25 to the SDCCRO as proof of correction.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tulam Vu
LICENSING EVALUATOR NAME:Jacqueline Macias
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JAMA, SHUKRI FAMILY CHILD CARE
FACILITY NUMBER: 376630001
VISIT DATE: 02/11/2025
NARRATIVE
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Licensee’s First Aid and CPR certification expires on 04/2025. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 02/12/2023. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 1/22/2025.

There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. Licensee shall physically check on sleeping infants up to 24 months of age every 15 minutes. Licensee states she conducts the 15 minutes checks on the infant in care but does not have documentation of the Infant sleeping log. An Individual Infant Sleeping Plan LIC 9227 shall be maintained for each infant up to 12 months of age. Licensee states she places up to 12 months of age on their backs for sleeping. LPA discussed the safe sleep regulations with licensee 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 (deficiency cited, see LIC 809D)

LPA also informed licensee 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.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided information regarding SIDS, Lead exposure and Shaken Baby Syndrome.

LPA and Licensee discussed California Megan's Law and LPA provided:www.meganslaw.ca.gov. During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA advised if there is an unusual incident to report to call Licensing within 24 hours and to follow up with an LIC624B within 7 days. In addition, for general questions, questions regarding licensing requirements call Child Care Licensing.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Jacqueline Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JAMA, SHUKRI FAMILY CHILD CARE
FACILITY NUMBER: 376630001
VISIT DATE: 02/11/2025
NARRATIVE
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Duty Line at (619) 767-2248. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov.

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 advised the Licensee that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed change.

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).

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

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.

Per California Code of Regulations, (Title 22, division 12 & Chapter 3) One (1) Type B is being cited on the attached LIC 809-D.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Jacqueline Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JAMA, SHUKRI FAMILY CHILD CARE
FACILITY NUMBER: 376630001
VISIT DATE: 02/11/2025
NARRATIVE
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A copy of the report, appeal rights (LIC 9058), and notice of site visit (LIC9213) was provided to Licensee and advised must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A Large Family Child Care Home license may be issued upon final file review.



An exit interview was conducted and report was reviewed with the licensee, Shukri Jama.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Jacqueline Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
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