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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376102185
Report Date: 08/27/2024
Date Signed: 08/27/2024 11:40:59 AM

Document Has Been Signed on 08/27/2024 11:40 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MOMAND, ULFAT BIBI FAMILY CHILD CAREFACILITY NUMBER:
376102185
ADMINISTRATOR/
DIRECTOR:		ULFAT BIBI MOMANDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 689-8442
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
08/27/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Ulfat MomandTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 8/27/24 at 10:35 AM Licensing Program Analyst (LPA) Annette Sutherland, met with Applicant Ulfat Bibi Momand, also present was 1 minor child. The purpose of this visit was for Pre-Licensing inspection for a change of location and a capacity increase. Fire clearance was requested on 8/2/24 and is pending inspection.

LPA toured the home. It is a one story, three-bedroom, one bathroom home. Applicant will be using the Family room, Kitchen, Bedroom #1 & 2, Bathroom #1, and patio. Off limit areas are bedroom #3 and side yard and are inaccessible by use of doorknob covers. The applicant has sufficient toys and equipment available. LPA did not note any hazardous items accessible to children. There are no bodies of water or weapons/firearms or ammunition in the home or on the property. Applicant does not have a fire extinguisher size (2A10BC or larger). The smoke detector/carbon monoxide detector combo is mounted on the wall by the front entrance and meet requirements and are operational Applicant’s Pediatric CPR/FA certification is valid through 12/17/24. All adults living or working in the home have been fingerprint cleared and associated and immunization requirements have been met. Control of property was verified. Outdoor side play area needs to clean up to be used. Licensee states that she will take children to nearby park for outdoor activities and understands supervision is always required.

Applicant was reminded of requirements for children’s records, child abuse reporting, unusual incident reporting, immunizations, criminal background clearance procedures and policies, posting requirements, capacity limitations and Shaken Baby Syndrome. Smoking in or around day care areas is prohibited.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MOMAND, ULFAT BIBI FAMILY CHILD CARE
FACILITY NUMBER: 376102185
VISIT DATE: 08/27/2024
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Applicant 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 Childcare 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.
Applicant is to be present in the home to ensure children are supervised and reminded that no children are to be left in parked vehicles and car seats are not to use used for sleeping. Capacity limitations were reviewed. LPA discussed California Megan's Law and the website was provided as follows: www.meganslaw.ca.gov

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 licensee [facility representative] 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. . Licensee is reminded that infants may not be swaddled while in care and walkers, exersaucers, jumpers, bouncy seats, napping portables and drop sided cribs are not permitted for use.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Childcare Homes Section 102417. When any IMS is provided, an updated Plan of Operation that includes 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.

Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MOMAND, ULFAT BIBI FAMILY CHILD CARE
FACILITY NUMBER: 376102185
VISIT DATE: 08/27/2024
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Corrections are required.
1. Facility is pending fire clearance.
2. Facility needs to purchase a fire extinguisher.



Once all corrections are made and proof is sent to licensing a license for 8 children may be granted. Applicant understands that proof of corrections must be submitted to Licensing within 30 days, or the application may be denied.


Upon final file review, the change of location will be granted, and a new license will be sent for posting. Applicants are reminded that the license is.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
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