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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622599
Report Date: 08/29/2019
Date Signed: 08/29/2019 01:29:50 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: 5DATE:
08/29/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Seham Asfour TIME COMPLETED:
01:45 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 five 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. LPAs toured the backyard and observed the pool fencing surrounds the underground pool and jacuzzi. The fencing does not meet requirement regulation requirement as indicated in Title 22 regulation - 102417.

Licensee will make fencing repairs to meet the regulation requirement. LPAs will return to inspect the fence once repairs are made.

Exit interview conducted and notice of site visit given to licensee and posted.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797-
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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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