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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300177
Report Date: 02/02/2022
Date Signed: 02/03/2022 01:50:18 PM

Document Has Been Signed on 02/03/2022 01:50 PM - 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:IBARRA FAMILY CHILD CAREFACILITY NUMBER:
336300177
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
02/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:AttemptedTIME COMPLETED:
09:10 AM
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On 02/02/22 Licensing Program Analysts (LPAs) Sumayya Habeebulla, Ana Noble, and Nasha King arrived at the facility to conduct a POC follow up visit. LPAs knocked at the door and there was no answer. LPAs listened and observed there were no movement inside the home. The only sound coming from the backyard was of a dog. LPA Habeebulla peeked through the window and did not see any movement inside the house. LPAs waited for a few minutes and then proceeded towards the neighbor’s home. LPAs knocked at the doors of neighbors on both sides of the house. There was no answer. LPA Habeebulla left a business card at the door with a note on it requesting Licensee to call back.
On 02/02/22 at 2:44 PM, LPAs returned to the facility for a second attempt. LPAs noticed that the business card was gone, and the curtains were drawn in such a way no one could see inside. LPA Habeebulla knocked at the door again, there was no answer and this time LPAs could not hear the dog also. LPA left another card requesting a call back. LPAs parked the car at a distance and waited for 15 minutes. No one showed up at the house. As LPAs were leaving a neighbor pulled up. LPAs introduced themselves and inquired with the neighbor if she has seen the Licensee in the past few days. The neighbor, Tamana Rayhan replied that she hasn't. She has only seen an Audi parked at the door and she has not seen any children also.
LPAs left the facility at 3:15 PM
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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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