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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628583
Report Date: 05/26/2020
Date Signed: 05/26/2020 04:20:29 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:CHEMSI, MOUNIA FAMILY CHILD CAREFACILITY NUMBER:
376628583
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
05/26/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Mounia ChemsiTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Michelle Palacio conducted a third announced Prelicensing inspection on May 26, 2020 at 3:30pm with applicant, Mounia Chemsi. Inspection was conducted via video conference (Facetime) due to the COVID-19 outbreak. LPA conducted a live video tour of the inside and outside of the facility. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This facility is a two story, five bedroom, three bathroom house.

ยท Applicant has purchased and installed a lock for the jacuzzi which locks and secures the lid. Pictures of the locking latch are also being provided.

LPA discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home.

A small license will be issued effective 05/26/2020.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Michelle PalacioTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2020
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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