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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627006
Report Date: 02/04/2020
Date Signed: 02/04/2020 02:58:16 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:ISMAIL, HIBO AHMAD FAMILY CHILD CAREFACILITY NUMBER:
376627006
ADMINISTRATOR:HIBO AHMAD ISMAILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 729-4906
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:14CENSUS: 0DATE:
02/04/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Hibo IsmailTIME COMPLETED:
03:10 PM
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Licensing Program Analysts (LPA), Tyra Block and Selina Saio, conducted an unannounced Case Management visit for the purpose of following-up with Licensee to ensure facility is operating within licensed capacity. Licensee was recently cited a Type A deficiency due to operating over capacity. Present today is Licensee and she stated her son was in the bedroom taking a nap. No day care children are present. LPAs retrieved a copy of the roster showing 6 children currently enrolled at the facility. No attendance sheets were available for review. Licensee stated she operates 5 days a week.

No corrections are needed or deficiencies cited today.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
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)
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