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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312946
Report Date: 12/02/2021
Date Signed: 07/03/2022 11:26:04 AM


Document Has Been Signed on 07/03/2022 11:26 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, 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: 0DATE:
12/02/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee Alia IbrahimTIME COMPLETED:
11:00 AM
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An Informal Office Meeting was conducted on this day in the Orange Regional Office via zoom application. Present during the meeting were Regional Manager (RM) Bertha Manzanares, Licensing Program manager (LPM) Thuy Ho, Licensing Program Analyst (LPA) Tina Nguyen and Licensee Alia Ibrahim.

The purpose of the Informal meeting was to discuss the most recent history of the facility. LPM, Ho & Regional Manager, Manzanares reviewed the history after the citation issued on August 3, 2021.



The Department has conducted (4) additional inspections: August 4, 2021, August 27, 2021, September 8, 2021 and October 20, 2021. During these current inspections the Licensee has remain in ratio and in most occasions, Licensee had (3) Staff members present; which exceed the Department regulations. The Staff members have also been following personnel requirements.

Based on the most recently history of the inspections the Department is receding the referral for an Administrative Action addressed during the Noncompliance Conference of August 6, 2021. However, you will still be place in the Required list. As a reminder during the Noncompliance Conference the following citation were discussed Staffing Ratio & Capacity, Criminal Record Clearance, and Personal Rights.
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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:
DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/02/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: IBRAHIM, ALIA
FACILITY NUMBER: 304312946
VISIT DATE: 12/02/2021
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The following was discussed with the Licensee:
1. The licensee was advised that it is her responsibility to know & understand the requirements of Title 22 Regulations.
2. The licensee’s facility must always comply.
3. The licensee was advised to check the Child Care Licensing web site at www.ccld.ca.gov for quarterly updates, forms and regulations.
4. Licensee will be put on required visits for two years.

RM Manzanares explained If subsequent repeated violations are cited in the future and the Department determines that the facility has violated the law/regulations or is inadequately implementing the approved plans to remedy the facility's noncompliance, the Department, in its discretion, will seek formal legal action.

Exit interview conducted with licensee. RM explained to licensee that a copy of this office visit report would need to be given to parents of all children in care and the Acknowledgement form would need to be signed and placed in each child's file. A copy of report would need to be provided to all new parents for the next twelve months.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC809 (FAS) - (06/04)
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