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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100987
Report Date: 05/18/2022
Date Signed: 04/29/2024 04:01:22 PM

Document Has Been Signed on 04/29/2024 04:01 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
SAN DIEGO N. CC RO, 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: 1DATE:
05/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Gulsoom MonqadTIME COMPLETED:
01:40 PM
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On 5/18/22 at 12:30 PM Licensing Program Analyst (LPA) Adrian Mangina conducted a Plan of Correction visit to the child care home to follow-up on deficiencies cited during Case Management – Licensee initiated on 04/08/22. LPA met with Licensee Gulsoom Monqad. Also, in the home was Licensee’s husband, Atiquillah Monqad who provided translation, there was one minor child in the home and no children in care. Proper ratios and supervision were observed. When LPA arrived Atiquillah handed LPA staff files which did not contain Mandated reporter certificates, LIC9108: Statement Acknowledging Requirement to Report Child Abuse and of LIC9052: Employee Rights.

During the visit LPA verified that the following were completed:

1) Roster updated to include enroll dates and physician information
2) Child files are complete

The following corrections are still needed before increase in capacity can be granted:

1) Mandated reporter training for Atiquillah Monqad and Muzzamil Monqad
2) Signed LIC9108 for Atiquillah Monqad and Muzzamil Monqad
3) Signed LIC9052 for for Atiquillah Monqad and Muzzamil Monqad

No deficiencies were cited

Exit interview conducted and report was reviewed with the licensee, Gulsoom Monqad. Notice of Site Visit (LIC9213) was also provided and must be posted for 30 consecutive days. . Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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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