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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629834
Report Date: 03/18/2024
Date Signed: 03/18/2024 10:30:32 AM

Document Has Been Signed on 03/18/2024 10:30 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:ALI, MARYAM FAMILY CHILD CAREFACILITY NUMBER:
376629834
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/18/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maryam AliTIME COMPLETED:
09:45 AM
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On March 18th, 2024, at 9:00 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced capacity increase inspection. Licensee Maryam Ali as advised of the meeting’s purpose and granted LPA facility entry.

On 02/22/2024, Licensee submitted an application (LIC 279) requesting a capacity increase. The provider has at least one year of experience as a regulated small family childcare home operator. The Licensee’s prior home was previously licensed on 02/28/2019 but closed in 2024 when they relocated to their present site. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 03/05/2024 for fourteen (14) children. The facility is a five (5) bedroom, two (2) bathroom house with one floor. The following areas used for childcare are: the living room, dining room, one (1) bathroom and two (2) bedrooms. The off-limits areas include kitchen, remaining bedrooms, and remaining bathroom.

Licensee accompanied LPA on a tour of the home, as shown on the updated facility sketch. Background criminal record clearances were verified and discussed. First Aid and CPR certifications expire in September 2024. Licensee was reminded to update their pediatric First Aide and CPR certifications and obtain its completion card before September 2024. The facility has a working 2A10BC fire extinguisher, smoke alarms, carbon monoxide, and a first aid kit in place. The last safety drill was in 02/13/2024. There are no bodies of water on the premises. Per the Licensee, no weapons or ammunition are housed in the facility. The daycare schedule is weekdays 6 AM to 11 PM and weekends 8 AM to 11:30 PM.

Licensees of family day care homes shall ensure that at least one staff member shall always be onsite when children are present at the facility and shall be present with the children when children are offsite from the facility for facility activities. The Licensee shall ensure at least one staff member has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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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: ALI, MARYAM FAMILY CHILD CARE
FACILITY NUMBER: 376629834
VISIT DATE: 03/18/2024
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Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority. Prior to employment or initial presence in the childcare home, all employees subject to a criminal record review shall: obtain a California clearance or a criminal record exemption as required by law or Department regulations or request a transfer of a criminal record clearance. The Licensee shall not employ a staff member if they have not been immunized against influenza, pertussis, and measles. Each employee shall receive an influenza vaccination between August 1 and December 1 of each year. The employee may submit a yearly written declaration attesting that they have declined the influenza vaccination. This exemption applies only to the influenza vaccine. Documentation of immunizations is to be maintained in the staff’s facility personnel record. The Licensee shall provide each employee with a copy of the Notice of Employee Rights (LIC 9052) form furnished by the Department. Each employee shall be requested to sign and date the notice form acknowledging receipt. A copy of the signed notice form shall be retained in the employee's personnel record. If the employee refuses to sign the notice form, a dated notation to that effect shall be retained in the employee's personnel record.

The Licensee was provided with the Ratio/Capacity Worksheet for a large family childcare home. The Licensee acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensee shall comply with the capacity requirements for a Small Family Child Care Home.

In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) of children is approved. A new license will be generated and mailed to the licensee.

A notice of site visit was given to the licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. The exit interview was conducted, and report was reviewed with the Licensee Maryam Ali.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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