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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100558
Report Date: 03/24/2022
Date Signed: 03/24/2022 10:52:03 AM


Document Has Been Signed on 03/24/2022 10:52 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:MOHAMOUD, FOSIYA FAMILY CHILD CAREFACILITY NUMBER:
376100558
ADMINISTRATOR:FOSIYA MOHAMOUDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 962-3375
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:14CENSUS: 0DATE:
03/24/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Fosiya MohamoudTIME COMPLETED:
10:55 AM
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On March 24, 2022 at 10:20 a.m. Licensing Program Analyst (LPA), Leilani Curtis conducted an unannounced inspection. Upon arrival LPA met with Licensee Fosiya Mohamoud and toured the facility. Also present was the licensee's adult daughter Hinda Mohamoud and adult son Abdul Jabbar Mohamoud. There were no children present. Licensee states that she provides care to children in the afternoons, Monday-Friday, from 3:30 p.m.-9:30 p.m. as well as on Saturday and Sunday (times vary). The licensee did not provide care to children yesterday, 3/23/22, today, or tomorrow (3/25/22) due to construction on the home.

The purpose of today’s inspection is to verify that the deficiency related to the licensee’s failure to maintain a children’s roster cited on LPA Leilani Curtis’s annual inspection dated 12/1/21 has been addressed. During today’s inspection LPA Curtis obtained a copy of the licensee’s roster, LIC9040.

No deficiencies are cited.

LPA reviewed this report with Licensee. The licensee was provided a copy of her appeal rights (LIC 9058 01/16) and her signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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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