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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100485
Report Date: 11/16/2020
Date Signed: 11/16/2020 02:05:00 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:FAKHRI, MUZHGAN FAMILY CHILD CAREFACILITY NUMBER:
376100485
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
11/16/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Muzhgan FakhriTIME COMPLETED:
02:32 PM
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On 11/16/2020 at 1:30 PM, Licensing Program Manager (LPM) Renesha Pack and Licensing Program Analyst (LPA) Keturah Lane conducted an office meeting with Licensee Muzhgan Fakhri at the San Diego North Regional Office. The purpose of the meeting was to clarify staffing ratio and capacity regulations for a small and large family child-care home. Licensee has submitted an application for a capacity increase and all documents requested have been submitted. Fire clearance was requested on 11/2/20 and is still pending.

On 10/27/20, a complaint visit was conducted with Licensee’s previous facility #376627746 and the facility was cited for the following deficiencies Staffing Ratio and Capacity 102416.5(a) for caring for 15 children at one time. Licensee stated at office visit that her own 3 children, under the age of 10 years, are not in the home during daycare hours or when daycare children are present. Licensee was made aware the having her own children present during daycare hours could put her over capacity. Licensee is aware that she needs to remain within licensed capacity at all times.

The following documents were reviewed and provided to Licensee: Title 22 Regulations (102416.5) Staffing Ratio and Capacity, Ratio handouts for small and large FCCHs, LIC311D Records to Keep in your Family Child Care Home, LIC9232 FCCH Checklist to Provide to Licensee During Annual Inspections, LIC9150 Parent Notification Additional Children in Care, FCCH Self-Assessment Guide and LIC9224 Acknowledgement of Receipt of Licensing Reports.

Licensee was provided a copy of the LIC809 report and Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2020
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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