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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101038
Report Date: 07/27/2023
Date Signed: 07/27/2023 05:08:14 PM

Document Has Been Signed on 07/27/2023 05:08 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:AYOOB, ANN FAMILY CHILD CAREFACILITY NUMBER:
376101038
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 12CENSUS: 4DATE:
07/27/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Licensee, Ann Ayoob TIME COMPLETED:
09:30 AM
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Licensing Program Analyst, Jennifer Lott conducted an announced Case Management visit for an increase in capacity from eight (8) to fourteen (14) children. LPA was greeted at the front door by Licensee, Ann Ayoob and granted entry after identifying herself and disclosing the purpose of her visit.

On 01/03/2023, the licensee submitted an application (LIC 279) to request an increase of capacity. The Fire Safety Inspection Request (STD 850) was approved by the local Fire Marshal and GRANTED the capacity increase to fourteen (14) children on 07/25/2023.
LPA conducted an inspection of home which includes # 3 bedrooms and #2 bathrooms with an attached garage. Licensee will be using the kitchen, dining room, living room, bedroom #3 and bathroom #1 for child care. Off limit areas include bedroom #1, bedroom/bathroom #2, garage and all outside. Smoke alarms and carbon monoxide detector are functional and meet statutory requirements. Fire extinguisher is installed in the kitchen and has been serviced.

Licensee was reminded of the staffing/capacity ratios for Large Family Child Care Homes. Twelve (12) children, no more than 4 infants (birth to 24 months) and 8 older children over the age of 2. A qualified assistant (age 14 or older) is required. For fourteen (14) children, no more than 3 infants (birth to 24 months) and 11 older children; at least 2 school age, 1 child at least age 6, 1 child enrolled in and attending kindergarten or elementary school. When there isn't a qualified assistant, licensee must follow Small Family Home Child Care Regulations.

No deficiencies were cited during today’s visit. A license for a capacity of fourteen (14) will be issued after final file review. An exit interview was conducted the report was reviewed with Licensee, Ayoob. A notice of site visit was given and most remain posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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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