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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628601
Report Date: 05/11/2020
Date Signed: 05/11/2020 01:14:00 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:FARAH, ASHO FAMILY CHILD CAREFACILITY NUMBER:
376628601
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
05/11/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Asho FarahTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a capacity increase tele inspection with Licensee Asho Farah. Due to the Covid 19 outbreak, this inspection was done as a tele inspection via Face Time. This meeting’s purpose 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.

On 04/30/2020, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 05/08/2020 for 14 children.

This is a one story, three bedroom, two bathroom home. The off limits areas include the bedrooms, one bathroom, kitchen and an unattached garage. The following rooms will be used for care: living room, family room and one daycare bathroom

Licensee accompanied LPA on a tour of the home, as shown on the updated facility sketch. Background criminal record clearances were verified and discussed. Facility has two working 2A10BC fire extinguishers. The smoke alarm and carbon monoxide detector are operational. The first aid kit is in place. 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) of children is approved today 05/11/2020. 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. On 05/11/2020, a copy of the facility's new digitalized facility profile will be emailed to the Applicant to demonstrate current licensed capacity.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: FARAH, ASHO FAMILY CHILD CARE
FACILITY NUMBER: 376628601
VISIT DATE: 05/11/2020
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An exit interview was conducted. A copy of this report and Licensee 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: 05/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020
LIC809 (FAS) - (06/04)
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