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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101121
Report Date: 03/12/2024
Date Signed: 03/12/2024 12:46:03 PM

Document Has Been Signed on 03/12/2024 12:46 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JERJISS, SREENA FAMILY CHILD CAREFACILITY NUMBER:
376101121
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 15CENSUS: 0DATE:
03/12/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sreena JerjissTIME COMPLETED:
01:00 PM
NARRATIVE
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On 3/12/24 at 9:30am Licensing Program Analyst (LPA) Patrick Ma conducted an unannounced inspection for an increase in capacity application. Licensee submitted application to the Department on 2/2/24. Fire clearance was completed on 2/15/24. Also, in the home was husband Awni Jerjiss. The 2 story home was toured and inspected to ensure an environment safe for the care and supervision of children. There were no children in care.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include kitchen, living room, dining room, downstairs bathroom. Off limits areas include outdoor patio and entire second floor and are inaccessible through use of door knob covers and child safety gate at bottom of stairs. The licensee has sufficient toys and equipment available. There is a nearby park that Licensee takes the children to for outdoor activities. Licensee understands that supervision is required at all times during outdoor activities.

The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. Hazardous items under the kitchen sink and bathroom sink were not properly latched/locked where bleach, cleaning solutions, and toilet cleaning chemicals were accessible to children. There is no body of water on the property. Licensee states that there are no weapons in the home. First Aid and CPR certifications expire on 8/2025. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 2/24/24 and is reminded it must be completed every 2 years. Children’s and Staff records were reviewed.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; 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.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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 03/12/2024 12:46 PM - It Cannot Be Edited


Created By: Patrick Ma On 03/12/2024 at 11:26 AM
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: JERJISS, SREENA FAMILY CHILD CARE
FACILITY NUMBER: 376101121

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/12/2024
Section Cited
CCR
102417(g)(4)

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102417(g)(4) Operation of a Family Child Care Home: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement was not met as evidenced by:
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During inspection, Licensee adjusted and tightened latches to perform properly. Deficiency was cleared during site visit.
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Based on observation, Licensee's latches under kitchen and bathroom sink did not latch properly where bleach, cleaning compounds, and toilet cleaning chemicals were stored which poses an immediate hazard to the health and safety of children in care.
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Type B
03/29/2024
Section Cited
CCR102416.1

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102416.1 Personnel records shall be maintained on each employee...
This requirement was not met as evidenced by:
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LIcensee stated she will submit proof of all helper documents for husband to the Department by POC due date.
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Based on file review and interview, Licensee stated helper/husband helps pick up school age children to the facility then quickly said "just once" when his file was requested for review but no helper documents were on file which poses a potential health and safety 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:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/12/2024 12:46 PM - It Cannot Be Edited


Created By: Patrick Ma On 03/12/2024 at 11:36 AM
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: JERJISS, SREENA FAMILY CHILD CARE
FACILITY NUMBER: 376101121

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
CCR
102425(c)

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102425(c) INFANT SAFE SLEEP: An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.
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LIcensee stated she will submit proof of completed Infant Sleep Plan for C1 to the Department by POC due date.
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Based on interview and records reviews, Child C1 was missing Infant Sleep Plan and Licensee stated she was unaware of the document which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
03/29/2024
Section Cited
CCR102425(j)(1-2)

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102425(j)(1-2) INFANT SAFE SLEEP: The provider shall supervise infants while they are sleeping and…check on the infant every 15 minutes…provider shall check and document.
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LIcensee stated she will submit proof of a sample of completed infant sleep logs for the 3 infants to the Department by POC due date and stated she will maintain them moving forward.
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Based on records reviews, 3 of 3 infant files reviewed were missing Infant Sleep logs which poses/posed a potential health, safety or personal rights risk to persons 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:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024


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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: JERJISS, SREENA FAMILY CHILD CARE
FACILITY NUMBER: 376101121
VISIT DATE: 03/12/2024
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including 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 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-andresources/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.

The licensee has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, if licensed, they can operate with a maximum capacity of 12 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted to increase the capacity and provide care to 14 children.

Capacity limitations were reviewed. Licensee is to be present in the home to ensure children are supervised and is reminded that the license is NOT transferable and should she relocate, this license will be null and void.

Licensee was reminded that annual fees are due on the date they were licensee every year.

See LIC809D for deficiencies cited.

LPA Ma informed licensee Sreena Jerjiss that this report dated 3/12/24 documents one Type A citation which shall be posted for 30 consecutive days as there were immediate risks to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
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: JERJISS, SREENA FAMILY CHILD CARE
FACILITY NUMBER: 376101121
VISIT DATE: 03/12/2024
NARRATIVE
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Also, LPA Ma informed the licensee to provide a copy of this licensing report dated 3/12/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The following corrections are needed:
• Proof of LIC 9224 signed by all enrolled parents
• Complete Infant sleep plan
• Sample of completed sleep logs for all 3 infants
• Completed required helper documents for Awni Jerjiss

Applicant understands that corrections must be submitted to the Department within 30 days or the application may be denied.

Exit interview conducted and report was reviewed with the applicant Sreena Jerjiss. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024
LIC809 (FAS) - (06/04)
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