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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101264
Report Date: 09/28/2023
Date Signed: 09/28/2023 02:22:14 PM

Document Has Been Signed on 09/28/2023 02:22 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 NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SOFI, HUSAM & ISMAEL, INTISAR FCCFACILITY NUMBER:
376101264
ADMINISTRATOR:HUSAM S. & INTISAR I.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 504-9389
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 0DATE:
09/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Husam Sofi & Intisar IsmaelTIME COMPLETED:
02:35 PM
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On 9/28/23 at 11:00 am Licensing Program Analyst (LPA) Gerald Poindexter conducted an unannounced annual inspection. Upon arrival, LPA met with Licensees Husam Sofi and Intisar Ismael. Also, in the home was Ali Husam, the licensees’ father and husband, respectively. There were no day care children present in the home. Licensee states they typically arrive at approximately 4 pm. The licensee was provided with the Inspection Checklist (LIC 126). The two story, five bedroom, three bathroom home with a two car garage, was toured and inspected to ensure an environment safe for the care and supervision of children.

The licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room, dining room, bathroom, kitchen, bedroom #1 (outside kitchen) and backyard. Off limits areas: bedroom #2 next to bathroom, garage, and entire 2nd floor, which are made inaccessible by use of doorknob covers, lock/latch, and safety gates, respectively. There are stairs in the home. Stairs are barricaded when children under age 5 years old are present. The facility has sufficient toys and equipment available.

The home has a fully fenced and gated backyard with a play structure available for outdoor activities. LPA observed the play structure, which was is intended for ages 3-11, and reminded licensee to follow the age restrictions/guidance. The licensee understands that visual supervision is always required during outdoor activities. No body of water was observed during time of inspection.

There is a fully charged fire extinguisher, smoke and carbon monoxide detector that meet requirements and are operational. There is locked/screened fireplace in the living room that is inaccessible to children. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children via latched cabinets and drawers. Adequate heating and ventilation are provided. There is a working telephone/email address. Licensee stated there are NO firearms and weapons in the home.

CONTINUED ON PAGE 2

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SOFI, HUSAM & ISMAEL, INTISAR FCC
FACILITY NUMBER: 376101264
VISIT DATE: 09/28/2023
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LPA observed all required postings were posted, except for the Parent's Rights Poster (PUB 394). LPA provided a copy for posting. Children’s records were reviewed and found to be incomplete. Staff records were reviewed. Licensees have the required immunizations per SB792. Both licensees’ Pediatric CPR/First Aid are current with an expiration date of 4/5/2025. Preventative health practices course was completed. Licensees are exempt from Mandated Reporter AB1207 training certification due to having limited English proficiency, Licensee’s primary language is Arabic.

Emergency drills are conducted and documented with the last one being on 7/28/23. Licensee maintains a current roster of the children which LPA obtained during time of inspection. LPA verified that all adults living or working in the home have been fingerprint cleared and associated. LPA reminded Licensee that all unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619) 767-2203. Duty officer number is (619) 767-2248.



The 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.

LPA conducted child care quality management staff interview with the licensee. 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-andresources/safe-sleep as an 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.

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SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
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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 NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: SOFI, HUSAM & ISMAEL, INTISAR FCC
FACILITY NUMBER: 376101264
VISIT DATE: 09/28/2023
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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/.

The 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.

See LIC809D for deficiency cited.



Exit interview conducted and report was reviewed with the licensee Husam Sofi and Intisar Ismael. During the exit interview, the licensees, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/28/2023 02:22 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 09/28/2023 at 01:31 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: SOFI, HUSAM & ISMAEL, INTISAR FCC
FACILITY NUMBER: 376101264

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(d)
(d) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child's record, proof of parent notification that the facility is caring for an additional child as required in Section 102416.5(h).
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and licensee statement, the licensee did not comply with the section cited above. The licensees have 11 children in care and do not maintain the LIC9150, Notification of Additional Children in Care, in each child's file. Specifically, the LIC9150 does not contain the current address, but rather the licensees’ previous address and parent’s signatures that acknowledge to that address. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2023
Plan of Correction
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The licensees state that they will have the parent/guardians of all children enrolled complete the LIC 9150, Additional Children in Care form. The licensee will email a copy of the signed form for each child enrolled by POC due date of 10/28/23.
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:Renesha Askew
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023


LIC809 (FAS) - (06/04)
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