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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700104
Report Date: 02/09/2021
Date Signed: 02/09/2021 02:18:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BAWAZIR, AMEERA & GHNIMAT, FERASFACILITY NUMBER:
015700104
ADMINISTRATOR:BAWAZIR, AMEERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 480-8126
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:14CENSUS: 3DATE:
02/09/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Ameera BawazirTIME COMPLETED:
02:10 PM
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At 1:53pm on 2/09/2021, Licensing Program Analyst (LPA) Morgan Pringle conducted an Announced Case Management Tele Visit inspection with Licensee Ameera Bawazir. This inspection was for the purpose of changing the back bedroom from off limits to on limits. LPA and Licensee toured the room. The room is equipped with proper play materials, is well ventilated, and is free from all hazards. A new facility sketch was submitted to LPA on 1/16/2021 and shows the new on limits area.

LPA has approved the bedroom for an “on limits” area.

A copy of this report was emailed to Licensee for her records.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2021
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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