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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101358
Report Date: 10/30/2023
Date Signed: 10/30/2023 10:32:19 AM

Document Has Been Signed on 10/30/2023 10:32 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:ALHUSSEIN, RAFAA FAMILY CHILD CAREFACILITY NUMBER:
376101358
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/30/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Rafaa AlhusseinTIME COMPLETED:
11:00 AM
NARRATIVE
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On 10/30/23 @ 8:56AM, Licensing Program Analyst (LPA) Nancy Diaz conducted an unannounced case management inspection. This is in reference to Mrs. Alhussein's request to increase her capacity to 14 children. LPA met and toured the home with licensee, Rafaa Alhussein. Also present today were licensee's husband, Mohanad Alajrab and their 15-year old son who helped translate this inspection in Arabic. There were no children present during this inspection.

The licensee will be using the following areas for daycare: kitchen, living room, bedroom #2, hallway bathroom, back room behind the kitchen and front/backyard. Off limit areas include: bedroom #1, bathroom #1 and laundry room. Mrs. Alhussein stated that the trampoline in the backyard is off limits to children. Fire Marshall clearance was received from the Heartland Fire & Rescue on 10/24/2023.

LPA discussed safe sleep regulations with the applicant, 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 additional resource. LPA also informed the 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 CPSC to be notified of any recalls on their purchased equipment.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 minimum/day up to $500 maximum per day/per person will be assessed if the regulation is violated.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2023
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: ALHUSSEIN, RAFAA FAMILY CHILD CARE
FACILITY NUMBER: 376101358
VISIT DATE: 10/30/2023
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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) or (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.

Applicant was informed of the myChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

TYPE B DEFICIENCIES WERE CITED TODAY. Type B deficiencies if not corrected poses a potential risk to the health, safety or personal rights of children in care.

Capacity shall include children under age 10 who reside at the licensee’s home.

An exit interview was conducted with the applicant. A copy of this report and appeal rights were provided. Notice of site visit was given and observed posted. The notice must remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
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Document Has Been Signed on 10/30/2023 10:32 AM - It Cannot Be Edited


Created By: Nancy Diaz On 10/30/2023 at 09:41 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: ALHUSSEIN, RAFAA FAMILY CHILD CARE
FACILITY NUMBER: 376101358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2023
Section Cited
CCR
102417(g)

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OPERATION OF A FAMILY CHILD CARE LICENSE. 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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Mrs. Alhussein stated that she will remove the following from her yard: construction material, pieces of wood, lawn mowers and bar-b-que grill no later than 11/6/23. She will email photos to show that they removed the items from the front and back yard no later than 11/6/23.
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Based on observation, children have access to the construction material, pieces of wood, lawn mowers and bar-b-que grill that is stored in the front and back yard.
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Type B
11/06/2023
Section Cited
CCR102417(g)(8)

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OPERATION OF A FAMILY CHILD CARE HOME. Each family child care home shall have a current roster of children...

This requirement was not met as evidenced by:
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LPA provided form LIC 9040 to Mrs. Alhussein today. She stated that she will complete the form no later than 10/30/23.
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Based on file review, Mrs. Alhussein did not maintain a roster of 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:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023


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Document Has Been Signed on 10/30/2023 10:32 AM - It Cannot Be Edited


Created By: Nancy Diaz On 10/30/2023 at 10:07 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: ALHUSSEIN, RAFAA FAMILY CHILD CARE
FACILITY NUMBER: 376101358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2023
Section Cited
CCR
102417(g)(9)

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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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Mrs. Alhussein stated that she will conduct a fire drill with the children no later than 11/06/23.
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Based on document/file review, Mrs. Alhussein has not conducted a fire drill since 1/8/2023.
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Type B
11/06/2023
Section Cited
CCR102421(b)

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CHILD'S RECORDS.
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card ...
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LPA provided Mrs. Alhussein a complete packet of children's forms. Mrs. Alhussein stated that she will provide the forms to the parents for completion no later than 11/6/23.
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The licensee did not maintain complete children's records on file. Some of the forms reviewed today were incomplete.
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Mrs. Alhussein will make an appt. with LPA to review the completed children's files no later than 11/06/23.
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:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023


LIC809 (FAS) - (06/04)
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