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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622599
Report Date: 06/11/2021
Date Signed: 06/11/2021 11:23:57 AM

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:
06/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Seham AsfourTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Elvira Sierra and Licensing Program Manager (LPM) Bettina Engelman conducted a case management inspection for the purpose of updating licensee's off limits areas. LPA and LPM met with Licensee, Seham Asfour. Upon arrival 2 staff were present caring for 5 children.

Licensee is requesting to make the backyard off limits on today's visit. Backyard will be part of the off limits areas after today's inspection. Licensee understands that children are not allowed to be in the off limits areas.

Licensee stated that the nearby park will be used for outdoor activities.

An exit Interview was conducted in which the report was reviewed and discussed with Licensee. A Notice of Site Visit will be provided via email to Licensee. Notice of Site Visit must be posted and remain posted for 30 days for public review.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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