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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623856
Report Date: 10/21/2021
Date Signed: 10/21/2021 02:02:52 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:HAYDER, SAHRA FAMILY CHILD CAREFACILITY NUMBER:
376623856
ADMINISTRATOR:HAYDER, SAHRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 565-4745
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:14CENSUS: 3DATE:
10/21/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Sahra HayderTIME COMPLETED:
09:30 AM
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On October 21st, 2021 at 08:50 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to amend the report dated 09/08/2021. LPA advised Licensee Sahra Hayder of the meeting’s purpose and was granted facility entry.

There were three (3) toddlers/preschoolers (2 years to 5 years) supervised by the Licensee and staff. One of the children was the Licensee's biological child. There were neither infants nor school aged children present during the inspection.

No deficiencies cited.

The Notice of Site Visit (LIC 9213) is to be posted for thirty (30) days. This notice was provided to the Licensee, who posted this document in LPA’s presence. An exit interview was conducted with staff. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to Licensee Sahra Hayder; her signature on this form confirms receipt of these rights.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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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