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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100987
Report Date: 03/24/2022
Date Signed: 03/24/2022 09:50:49 AM

Document Has Been Signed on 03/24/2022 09:50 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:MONQAD, GULSOOM FAMILY CHILD CAREFACILITY NUMBER:
376100987
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Gulsoom MonqadTIME COMPLETED:
09:09 AM
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On March 24, 2022 at 8:55 a.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced inspection. Upon arrival LPA met with Licensee Gulsoom Monqad and proceed to tour the facility. Also present was the licensee's husband Atiqullah Monqad and adult son Muzzamil Monqad. Atiqullah Monqad translated for the licensee. The licensee’s primary language is Farsi. There were no daycare children present. The purpose of today’s inspection is to deliver the findings on an investigation regarding the licensee’s previous license, facility #376626727.

No deficiency cited today.

An exit interview was conducted with the licensee and appeal rights (LIC 9058 1/16) were discussed. A copy of this report as well as a copy of the appeal rights were given to the licensee. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the licensee post Notice of Site Visit.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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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