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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100139
Report Date: 10/15/2019
Date Signed: 10/15/2019 03:00:02 PM

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:WARSHAN, MARIAM FAMILY CHILD CAREFACILITY NUMBER:
376100139
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
10/15/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Mariam WarshanTIME COMPLETED:
03:05 PM
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On 10/15/19 at 2:40 p.m. Licensing Program Analysts (LPAs) Brooke Sykora and Michael Morales-Desilvestore conducted an announced prelicensing inspection with applicant Mariam Warshan. The applicant's daughter, Adina Nooristani, was also present and assisted with translating in Dari. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This four bedroom, two bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. The hours of operation are Monday through Sunday 6:00 a.m. to 12:00 a.m.

All poisons, detergents, cleaning compounds, and medicines are inaccessible to children in care and are located in off limit areas with door locks and cabinet latches and secured out of reach of children. Applicant has furnished the home and barricaded the air conditioning unit in the backyard. The applicant has also added a safety gate to the hallway making bedroom #3 and bedroom #4 off limits for daycare children.

No corrections are needed. A small Family Child Care License will be issued upon final file review. An exit interview was conducted and a copy of the report was provided to the applicant.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke SykoraTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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