Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623205
Report Date: 07/16/2019
Date Signed: 07/16/2019 03:08:30 PM

COMPREHENSIVE INSPECTION
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:MOHAMOUD, FARDOS & MOHAMED, MOHAMED FCCHFACILITY NUMBER:
376623205
ADMINISTRATOR:F.MOHAMOUD/M.MOHAMEDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 795-7507
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:14CENSUS: 0DATE:
07/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Fardos MohamoudTIME COMPLETED:
03:10 PM
NARRATIVE
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LPAs, Luigi Gargaro and Dana Stevens, conducted an unannounced inspection with the licensee. The town home was toured and inspected to ensure an environment safe for the care and supervision of children per the standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present was the licensee and her cleared and associated son Mohamed Mohamed and no day care children. The fire extinguisher and combination smoke and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water or weapons in the home. A review of staff records on this date indicates that all adults or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aid and CPR certifications expire on 04/10/21 for the licensee and January of 2020 for her helper son, Mohamed Mohamed. Children’s records were reviewed and found to be in order.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include the kitchen, the living room, the dining area and the bathroom. Off limits areas include the entire upstairs and is inaccessible through use of an installed safety gate at the bottom of the home staircase. The licensee also has a back patio area that leads out into the neighborhood street that is also off limits. It is made that way with a bolt lock. The licensee has sufficient toys and equipment available. Licensee's complex has a facility playground that the provider uses for outdoor activities. Licensee was reminded that whenever she takes the children to the playground for outdoor play she must always provide direct supervision as the playground is in an area that is shared by all the tenants in the complex and she must always monitor them to ensure their health and safety.

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.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: MOHAMOUD, FARDOS & MOHAMED, MOHAMED FCCH
FACILITY NUMBER: 376623205
VISIT DATE: 07/16/2019
NARRATIVE
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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.

Licensee was cited one type B violation during today's visit (see related 809D citation page). 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.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MOHAMOUD, FARDOS & MOHAMED, MOHAMED FCCH
FACILITY NUMBER: 376623205
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2019
Section Cited
CCR
102417(g)(3)
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Operation Of A Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Where children less than five years old are in care, stairs shall be fenced or barricaded.
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Licensee has until 07/22/19 within which to replace the gate and send analyst a photo demonstrating that the correction has been completed.
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This requirement was not met when gate at bottom of staircase was in disrepair and was not able to latch. Though a barrier is in place, having one that does not fully close is a potential risk to children in care.
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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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
LIC809 (FAS) - (06/04)
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