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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628169
Report Date: 08/01/2019
Date Signed: 08/02/2019 07:34:30 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:MOHAMED, MASBAL FAMILY CHILD CAREFACILITY NUMBER:
376628169
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
08/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Masbal MohamedTIME COMPLETED:
12:15 PM
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LPA Adrian Castellon conducted an unannounced case management inspection on this date. LPA Castellon met with licensee Masbal Mohamed and discussed the purpose of the inspection. There were 3 children present along with the licensee's mother.

LPA Castellon toured the facility on this date. Licensee Mohamed submitted an increase in capacity application. A City of San Diego fire clearance report dated 06.12.19 has been received by the SDCCRO. The report finds no violations and the large license capacity is granted.

Licensee Mohamed understands that when providing care for more than 8 children, a fully qualified assistant must be present. No citations issued on this date.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: 619-767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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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