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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313131
Report Date: 01/25/2022
Date Signed: 01/25/2022 10:54:55 AM

Document Has Been Signed on 01/25/2022 10:54 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: 6DATE:
01/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee Ms. Omer, Maham TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Case Management Other inspection at the above Small Family Child Care home. Following up with the capacity requirements.

LPA met with the Licensee Ms. Omer, Maham who was observed to be providing care and supervision to 6 children between the ages of 2-5 years old. There were no infants in care.

On today's inspection Capacity requirements and Health & Safety code 1597.44 (c) and 1597.465(c) including LIC 9150 were reviewed by the LPA with the Licensee to ensure the operations at the Small Family Child care home are meeting the requirements. A copy of each form was given to the Licensee today.

LPA reviewed the files of the 6 children present at the home today with the Licensee.

Walk through of the home was completed. No deficiency cited on today's inspection.

Notice of site visit was posted on today's inspection.

Exit interview conducted and report was reviewed with the Licensee Ms. Omer, Maham and Appeal rights were presented.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2022
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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