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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100086
Report Date: 09/28/2021
Date Signed: 09/28/2021 04:24:42 PM

Document Has Been Signed on 09/28/2021 04:24 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:BOULES, HADEL FAMILY CHILD CAREFACILITY NUMBER:
376100086
ADMINISTRATOR:HADEL BOULESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 569-8246
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Shadah Tobya & Hadel BoulesTIME COMPLETED:
04:40 PM
NARRATIVE
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On 9/28/21 at 2:30 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced inspection with the Licensee. Upon arrival, LPA met with helper Shadah Tobya who was caring for 4 children. Ms. Tobya does not speak English (Chaldean only) and called Licensee who arrived within 5 minutes of LPAs arrival with 2 more children. Licensee asked if the inspection could be rescheduled and LPA Lane explained that the inspections are unannounced and that it would be completed today since there are children in care. Licensee had to leave at 3:00 PM to pick up more children and returned at 3:18 PM. Another child came at that time with her. During this time while Licensee was out, Ms. Tobya was caring for 6 children. Once Licensee returned there were a total of 7 children. The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Proper supervision and ratios were observed. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. There are no bodies of water on the property. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expire on 12/2021. Helper’s First Aid and CPR certifications expire on 9/2023. Licensee and staff meet immunization requirements. Mandated Reporter Training requirement has been waived due to language barriers. (Licensee and helper’s main language is Chaldean). Licensee maintains emergency records for children.

At 2:50 PM, LPA observed that garage door was easily opened and inside where chemicals accessible to children. Licensee stated that she misplaced the key and cannot lock it until she replaces the door lock. Licensee showed LPA that she already has the supplies for this and will fix it tonight. Licensee stated that the children will not play near the garage until the door is fixed. (continued on LIC809-C...)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: BOULES, HADEL FAMILY CHILD CARE
FACILITY NUMBER: 376100086
VISIT DATE: 09/28/2021
NARRATIVE
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Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include: living room, kitchen, kids bathroom, kids room #1 and kids room #2. Off limits areas include: residents room and bathroom and are inaccessible through use of latch locks. There is a working phone at the facility. The licensee has sufficient age appropriate, safe, toys and equipment available. The home has a fenced backyard available for outdoor activities.

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D).

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; 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. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Lane reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA Lane directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm.

An exit interview was conducted with the Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) along with the report (LIC809) and their signature on this form acknowledges receipt of these rights. The LIC 9213 (Notice of Site visit) was posted during today's visit. Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/28/2021 04:24 PM - It Cannot Be Edited


Created By: Keturah Lane On 09/28/2021 at 03:58 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: BOULES, HADEL FAMILY CHILD CARE
FACILITY NUMBER: 376100086

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2021
Section Cited
CCR
102417(g)(4)

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102417 Operation of a Family Child Care Home - (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include...(4) Poisons, detergents, cleaning compounds...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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Licensee stated she lost the key to the garage and is fixing it tonight so it will be locked. Until it is fixed, Licensee stated that the children will be kept away from the garage. Licensee will send a video by 9/30/21 to LPA Lane at:
[email protected] showing that the door has been installed with a new lock.
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Based upon LPA observation, garage door was accessible to children. Inside the garage were chemical compounds and other items. However, children were not outside at the time of inspection which is 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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2021


LIC809 (FAS) - (06/04)
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