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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313131
Report Date: 12/15/2021
Date Signed: 12/15/2021 09:52:25 AM

Document Has Been Signed on 12/15/2021 09:52 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:OMER, MAHAMFACILITY NUMBER:
304313131
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
12/15/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee Ms. Omer, Maham TIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Ketki Desai, made an unannounced Case Management inspection at the above Family Child Care home, following up on the inspection completed on 12-07-2021.

On today's inspection, Licensee is in compliance with the ratio required for a small Family child care home.
LPA also observed the required posting posted for Type A citation issued on 12/7/21. Acknowledgement form LIC 9224 has been issued to the parents for signature.

Children present were in the age range of 2-5 years old as indicated on the application. There were no infants present.

No deficiency issued on today's case management inspection.

Exit interview held, Appeal Rights and Notice of site visit was posted again today.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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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