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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628593
Report Date: 06/23/2020
Date Signed: 06/23/2020 01:09:42 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:ALEMU, TEGEST FAMILY CHILD CAREFACILITY NUMBER:
376628593
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 12DATE:
06/23/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tegest AlemuTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a pre-licensing inspection with Licensee Tegest Alemu. Due to the Covid 19 outbreak, this inspection was done as a tele inspection via Face Time. Said Abinow, of the Somali Bantu Association assisted with Somali translation. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for large Family Child Care Homes.

The Licensee was originally granted a capacity emergency waiver. On 05/08/2020, Licensee submitted an application (LIC 279) requesting the capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 06/19/2020 for fourteen (14) children. This is a one story, four bedroom, three bathroom single family house. The Licensee uses the following areas for childcare: one bedroom, one bathroom and the living room. The off limits areas include the remaining bedrooms, remaining bathrooms, laundry room and kitchen. Licensee accompanied LPA on a tour of the home, as shown on the facility sketch. Background criminal record clearances were verified and discussed. First Aid and CPR certifications expire in 12/2021. Facility has working 2A10BC fire extinguisher, smoke alarms, carbon monoxide, and the first aid kit in place. The last safety drill was on 06/19/2020. There are no bodies of water on the premises. Per the Licensee, no weapons or ammunition are housed in the facility.

In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) children is approved. A new license will be generated and mailed to the provider.

LPA provided the Licensee with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. An exit interview was conducted. A copy of this report and Licensee/Appeal Rights (LIC 9058) will be e-mailed to the Applicant. The Applicant was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020
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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