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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627335
Report Date: 02/14/2022
Date Signed: 02/14/2022 01:50:52 PM


Document Has Been Signed on 02/14/2022 01:50 PM - 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:PASHA, SARA FAMILY CHILD CAREFACILITY NUMBER:
376627335
ADMINISTRATOR:SARA PASHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 888-2666
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:14CENSUS: 2DATE:
02/14/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Sara PashaTIME COMPLETED:
02:00 PM
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On 2/14/22 at 1:30 PM Licensing Program Analyst (LPA) Adrian Mangina conducted a Plan of Correction visit to the child care home to follow-up on deficiency cited during annual inspection on 1/25/22. LPA met with Licensee. Also in the home was Licensee’s husband Shakhawn Hussin and two minor children There were no children in care. Proper supervision and ratios were observed.

During the visit, LPA verified that:1) Child #1, Child #2, Child #3, Child #4, Child #5.

No deficiencies were cited during this visit.

Licensee was provided with a copy of this report (LIC809). Their signature on this form is acknowledgement of receipt. A Notice of Site Visit (LIC9213)was also provided and must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2022
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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