<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215915
Report Date: 07/09/2021
Date Signed: 07/09/2021 10:51:37 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:FAROOK FCC AKA SAFIA'S HOME DAYCAREFACILITY NUMBER:
566215915
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
07/09/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Fathima FarookTIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On July 9, 2021 at 9:19 am, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management - Licensee Initiated inspection. LPA met with Licensee Fathima Farook and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There was three (3) children in care at the time of the inspection.

On April 30, 2021, Community Care Licensing (CCL) received an application for an increase in capacity to a Large Family Child Care Home (FCCH) from the licensee. A fire clearance request was submitted to Los Angeles County Fire Department (LACFD) on April 30, 2021. On June 29, 2021 the facility was inspected by LACFD and received an approved fire clearance to become a Large FCCH. Facility annual required inspection was completed today, July 9, 2021 with no cited deficiencies.

Effective today July 9, 2021 facility is approved to be a Large Family Child Care with a maximum capacity of 14 children.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1