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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622599
Report Date: 09/12/2019
Date Signed: 09/12/2019 12:53:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ASFOUR, SEHAMFACILITY NUMBER:
393622599
ADMINISTRATOR:ASFOUR, SEHAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 513-4631
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:14CENSUS: 6DATE:
09/12/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:18 PM
MET WITH:Seham Asfour TIME COMPLETED:
01:05 PM
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Licensing Program Analysts(LPAs ) Stacey Williams and Marissa Soto conducted a case management inspection for the purpose of updating licensee's off limits areas. LPAs met with Licensee, Seham Asfour. LPAs observed six children supervised by Licensee and her assistant.

Licensee recently had an underground pool and jacuzzi installed in the backyard of the home. Licensee is requesting her backyard to be on limits and ensure pool fencing requirements are met for the recently installed above ground pool. LPAs toured the backyard and observed wrought iron pool fencing surrounds the underground pool and jacuzzi. The fencing surrounding the body of water is five feet high and completely surrounds the body of water. The bottom of the fence is less than two inches from the ground. The horizontal beams measure at 45 inches apart. Licensee demonstrated the fence gate closure which is self closing and latching and swung away from the body of water.

Based on today's inspection of Licensee's pool fencing for the above ground pool, the pool fence meets title 22 regulation requirements. Effective today, September 12, 2019 Licensee's backyard will be on limits. In addition to the pool fencing surrounding the underground pool in the backyard, Licensee has an alarm on the kitchen sliding door leading to the backyard that will remain on the sliding door as an additional source of security to ensure inaccessibility to the backyard for children in care.

Exit interview conducted and notice of site visit given to licensee.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019
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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