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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100171
Report Date: 02/04/2020
Date Signed: 02/04/2020 01:03:51 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:ALKHALEIF, ASMAA FAMILY CHILD CAREFACILITY NUMBER:
376100171
ADMINISTRATOR:ASMAA ALKHALEIFFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 631-9695
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:14CENSUS: 2DATE:
02/04/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Asmaa AlkhaleifTIME COMPLETED:
01:30 PM
NARRATIVE
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LPA Nancy Diaz conducted an unannounced case management inspection. Mrs. Alkhaleif was home today with her husband, Azzam Alkhaleif and their one-year old daughter. One daycare child arrived at 12:35pm.

This inspection was translated in Arabic by Language Link (Operator Almira #12481).

Type B deficiencies were cited today. Civil penalty were assessed for repeat violations.

An exit interview was conducted. Appeal rights were provided.
LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ALKHALEIF, ASMAA FAMILY CHILD CARE
FACILITY NUMBER: 376100171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2020
Section Cited

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OPERATION OF A FAMILY CHILD CARE.
An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
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This requirement was not met as evidenced by: Mrs. Alkhaleif's statement that she did not have the emergency information for children #1-#6 in her care. See LIC 811 for names.
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Type B
02/14/2020
Section Cited

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IMMUNIZATIONS.
The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
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This requirement was not met as evidenced by Mrs. Alkhaleif's statement that she did not maintain the immunization record for Child #5.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2