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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312946
Report Date: 08/04/2021
Date Signed: 08/04/2021 10:43:57 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:IBRAHIM, ALIAFACILITY NUMBER:
304312946
ADMINISTRATOR:IBRAHIM, ALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 931-7469
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:14CENSUS: 13DATE:
08/04/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee Alia IbrahimTIME COMPLETED:
11:00 AM
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On 08/04/2021, Licensing program manager (LPM) Thuy Ho and Licensing program analyst (LPA) Tina Nguyen conducted a follow-up proof of correction inspection, met with licensee, Alia Ibrahim who guided the analyst on a tour of the facility. LPM and LPA observed 3 infants, 5 preschool and 5 school-age children with 3 staff members including the licensee. 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 index clearances or exemptions. The facility is operating within its licensed capacity and within compliance of staffing ratios.

On 08/03/2021, an unannounced complaint inspection was conducted and a LIC 9099 was completed.
The following deficiencies that were previously cited on a LIC 9099 dated 08/03/2021 have been cleared:
1. Un-fingerprinted staff members were not present during today's inspection.
2. LPM and LPA observed 3 infants, 5 preschool children and 5 school-age children with 3 staff
members including the licensee during today's inspection.
3. LPM and LPA observed the licensee and two staff members were wearing masks during today's
inspection.

LPAs observed the Notice of Site Visit, the LIC 9099 Facility Evaluation Report, and the LIC 9099D from the previous visit dated 08/03/2021 posted at the posting board. Acknowledgement of Receipt of Licensing Reports LIC 9224 was also observed in the child's file.
No deficiency observed during today's inspection.
An exit interview was conducted, and a copy of this report was provided to licensee.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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