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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100700
Report Date: 03/20/2023
Date Signed: 07/11/2023 07:31:19 AM

Document Has Been Signed on 07/11/2023 07:31 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:SHAMOON, WARDYAH FAMILY CHILD CAREFACILITY NUMBER:
376100700
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Wardya ShamoonTIME COMPLETED:
10:15 AM
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On 3/20/23 at 8:30 AM Licensing Program Analyst (LPA) Adrian Mangina conducted a Case Management/Increase in capacity inspection of home with Licensees Wardya Shamoon. The purpose of the visit is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Licensee was in ratio and capacity with no children present. LPA used Language link interpreter Ahmad #15665 as translator.

The four Bedroom two bathroom, single story home, was toured and inspected to ensure a safe and healthful environment for children. The 2A10BC fire extinguisher, smoke detector and carbon monoxide detector are operational. Licensee states that there are no weapons in the home. There are no bodies of water on the premises. Licensee’s CPR and First aid certifications are valid through June 2024. Mandated reporter training was waived due to language proficiency. Assistant’s CPR/First aid expires March 2024 and Mandated reporter expires 1/18/25. Licensee and staff meet immunization requirements.

The following areas are used for the child care: living room 1, living room 2, kitchen, dining area, hallway, hall bathroom, bedroom 1, and bedroom 2. Off limit areas include: bedroom 3, bedroom 4 and attached garage. All poisons, cleaners, and hazardous items are inaccessible to children. Electrical outlets are covered, and window cords are kept out of reach. There are sufficient and appropriate toys and equipment available in the home and backyard for children’s use. Outdoor play area is a fully fenced backyard. Licensee advised to remove stationary bicycle and place in off limits side yard.

All adults in the facility have submitted or been cleared for criminal record and child abuse index clearances or exemptions. Licensees were reminded that all adults 18 and over living or working in the home, including

continued on LIC809 page 2

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023
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: SHAMOON, WARDYAH FAMILY CHILD CARE
FACILITY NUMBER: 376100700
VISIT DATE: 03/20/2023
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LIC809 page 2

employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA reviewed child and staff files and roster, which were complete. Last fire drill was conducted 1/5/23. Licensee advised to conduct earthquake drills at least every six months, in addition to fire drills.

Fire clearance was approved on 2/24/23.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances associated to the facility, corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Mangina directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.



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 discussed the safe sleep regulations with licensee [or facility representative] 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
continued on LIC809 page 3
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
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: SHAMOON, WARDYAH FAMILY CHILD CARE
FACILITY NUMBER: 376100700
VISIT DATE: 03/20/2023
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LIC809 page 3

additional resource. 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.

Per applicant operating hours are from Mon – Sunday 12:00 AM – 12:00 AM. LPA reviewed with Licensee capacity limitations, supervision, emergency drills. Child passenger law, unusual incidents reporting, Assembly Bill 633, AB 2084, mandated reporting, SIDS, and Shaken Baby Syndrome. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Licensee was given heat related tips. Licensee reminded that garage is never to be used for children in care.

The facility is in substantial compliance and no deficiencies are cited at this time. A large license is recommended and may be issued after a thorough file review.

Exit interview conducted and report was reviewed with the licensee Wardya Shamoon. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2023
LIC809 (FAS) - (06/04)
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