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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100991
Report Date: 01/25/2024
Date Signed: 01/25/2024 12:36:38 PM

Document Has Been Signed on 01/25/2024 12:36 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 N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MATY, LAKAA FAMILY CHILD CAREFACILITY NUMBER:
376100991
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lakaa Maty TIME COMPLETED:
12:50 PM
NARRATIVE
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On 1/25/2024 @ 11:00AM Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced case management inspection with licensee Lakaa Maty. Her sister, Luma Mati was also present and helped translate this inspection in Chaldean. Ms. Maty is requesting an increase of capacity to a large family child care home. Fire clearance was approved by the Lakeside Fire Prevention on 1/23/24.

A tour of the home was conducted with Lakaa Maty and Luma Mati to ensure an environment safe for the care and supervision of children.

Children have access to the living room, dining, kitchen, hallway bathroom, bedroom #2 and back fenced yard. Off-limits are - garage and Bedrooms #1, #3 and #4.

Facility maintains a smoke and carbon monoxide (combination) detector. Detector was tested today and was deemed operable. Facility maintains a regulation size Fire extinguisher.

Type B deficiencies were cited today. Type B deficiencies if not corrected poses a potential risk to the health, safety and personal rights of children in care.
License for an increase to be approved upon submission of corrections.
Exit interview was conducted with Ms. Maty. LPA reviewed and provided a copy of this report to Ms. Maty. Appeal rights and Notice of site visit were also given. Notice of site visit must be posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2024
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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Document Has Been Signed on 01/25/2024 12:36 PM - It Cannot Be Edited


Created By: Nancy Diaz On 01/25/2024 at 12:03 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: MATY, LAKAA FAMILY CHILD CARE
FACILITY NUMBER: 376100991

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/01/2024
Section Cited
CCR
102421(a)(1

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CHILD'S RECORDS.
The licensee shall keep the signed and dated notice form for at least three years...

This requirement was not met as evidenced by:
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LPA provided Ms. Maty copies of required forms. She stated that she will have parents complete the form no later than 2/1/24.
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Based on record review, licensee failed to maintain forms LIC 9150, LIC 995A and LIC 624.
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Type B
02/01/2024
Section Cited
CCR102417(g)(8)

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OPERATION OFA FAMILY CHILD CARE HOME.
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement was not met as evidenced by:
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Licensee stated that she will fill out form LIC 9040 and provide a copy to the department no later than 2/1/2024.
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Licensee did not maintain the require form LIC 9040 (Children's Roster) on file.
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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:Joelle Redding
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/25/2024 12:36 PM - It Cannot Be Edited


Created By: Nancy Diaz On 01/25/2024 at 12:14 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: MATY, LAKAA FAMILY CHILD CARE
FACILITY NUMBER: 376100991

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/01/2024
Section Cited
CCR
102417(g)(9)(A)

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OPERATION OF A FAMILY CHILD CARE HOME.
Each family child care home shall conduct fire drills and disaster drills at least once every six months.
This requirement was not met as evidenced by:
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Licensee stated that she will conduct a fire drill with the children no later than 2/1/2024. She will provide the department a copy of the fire drill log no later than 2/1/2024.
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Based on record review, Licensee has not conducted a fire drill since she was licensed in March 2022.
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Type B
02/01/2024
Section Cited
CCR102417(g)

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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.
This requirement was not met as evidenced by:
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There were no children present during this inspection. Licensee corrected the deficiencies by removing the chicken manure and potting soil and installing latches under the kitchen and bathroom sink.
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Based on observation, toxic items were observed accessible to children under the kitchen and bathroom sink and the back yard. Toxic items such as soap, cleanser, etc were accessible under the kitchen and bathroom sink. Chicken manure and potting soile were accessible to children in the backyard.
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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:Joelle Redding
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024


LIC809 (FAS) - (06/04)
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