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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603481
Report Date: 01/24/2024
Date Signed: 01/27/2024 11:27:39 AM

Document Has Been Signed on 01/27/2024 11:27 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MARYAM ARFFACILITY NUMBER:
374603481
ADMINISTRATOR:LEEDA DOSTFACILITY TYPE:
735
ADDRESS:9319 NORTHVIEW TERRACETELEPHONE:
(858) 348-7247
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 6CENSUS: 6DATE:
01/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Administrator Assistant Elizabeth GuthTIME COMPLETED:
03:38 PM
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
Licensing Program Analyst (LPA) Correia conducted a case management visit to advise facility staff a technical issue regarding a report generated on January 17, 2024 during an annual inspection.

A corrected version of the report was regenerated on January 24, 2024 and provided to Administrator Assistant Elizabeth Guth.

In regard to this Case Management visit there were no deficiencies cited. An exit interview was conducted with Administrator Assistant Guth, to whom a copy of this report will be provided. Signature below confirms receipt on the document.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2024
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