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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100030
Report Date: 10/20/2021
Date Signed: 10/20/2021 11:04:37 AM

Document Has Been Signed on 10/20/2021 11:04 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 STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ODEESH, TANYA FAMILY CHILD CAREFACILITY NUMBER:
376100030
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
10/20/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Tanya OdeeshTIME COMPLETED:
11:15 AM
NARRATIVE
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On 10/20/21 at 10:15 AM Licensing Program Analyst (LPA) Adrian Mangina made an unannounced visit in relation to a separate issue. LPA met with Licensee Tanya Odeesh. Also present in the home were Licensee's mother Maryam Georges, and Licensee's husband Thaer Issa and 4 daycare children. Proper supervision and ratios were observed. Language Link interpreter #14018 Farida provided interpretation from 9:15 to 10:00 when Licensee's friend Lubna Dawood took over translation.

During that visit LPA toured the facility and reviewed child files. LPA observed that 10 of 10 children's files consisted only of LIC700 and were Missing LIC627 Consent for Medical Treatment, LIC995A Notification of Parent's Rights, LIC9150 Parent Notification of Additional Children in Care, and LIC82 Affidavit Regarding Liability Insurance.

See LIC809D for deficiency cited.

An exit interview was conducted with the Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) along with a copy of this the report (LIC809) their signature on this form acknowledges receipt of these rights. LPA observed LIC 9213 (Notice of Site visit) was posted during today's visit. Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2021
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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Document Has Been Signed on 10/20/2021 11:04 AM - It Cannot Be Edited


Created By: Adrian L Mangina On 10/20/2021 at 10:38 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ODEESH, TANYA FAMILY CHILD CARE
FACILITY NUMBER: 376100030

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/19/2021
Section Cited
CCR
102421(e)

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Child's records: (a) The licensee shall maintain... each child's record...

This requirement was not met as evidenced by:
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Licensee will ensure that all 10 children in her care have complete files and will contact LPA so LPA can conduct a POC visit no later that close of business 11/19/21.
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Based on file review, Licensee had only LIC 700 in 10 of 10 child files which poses a potential health and safetynrisk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2021


LIC809 (FAS) - (06/04)
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