<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626182
Report Date: 11/03/2020
Date Signed: 11/03/2020 11:58:24 AM

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:SOFI, HUSAM & ISMAEL, INTISAR FAMILY CHILD CAREFACILITY NUMBER:
376626182
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
11/03/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:LicenseeTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/3/2020 @ 11:20 a.m., Licensing Program Analyst, Joelle Redding, conducted a Televisit, via Zoom, due to Covid 19 restrictions. The purpose of this visit is to evaluate the facility in relation to the Compliance plan initiated on 2/6/2019.

During this visit, LPA reviewed sign in and out sheets and quarterly self-assessment guides that were agreed upon during the Non-compliance conference. All paperwork is complete and on file. Licensee has recently had a RAST visit and is employing best practices per Department of Public Health guidelines. LPA verified that the smoke alarm, carbon monoxide detector and fire extinguisher are in working order. Licensee has one family of three children enrolled. LPA reviewed the children's records and found them to be complete.

No deficiencies are cited.

This report will be delivered via email. LPA confirmed a valid email: husamsofi@yahoo.com. Licensee's reply to the email will serve as confirmation of receipt.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020
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 1