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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101044
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:11:16 PM

Document Has Been Signed on 05/25/2022 03:11 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:POLIZA, RAWAA FAMILY CHILD CAREFACILITY NUMBER:
376101044
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/25/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Rawaa PolizaTIME COMPLETED:
03:15 PM
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On 05/25/2022 at 2:15pm, Licensing Program Analyst Selina Siao conducted a pre licensing follow up inspection to ensure the newly installed swimming pool meets the licensing regulation requirements.

The initial inspection was conducted by LPA Siao on 04/26/2022 and a video footage and photos of the newly installed removable fence was submitted to LPA on 05/23/2022. LPA inspected the pool fence that is five feet high and there is a door that swings away from the pool that self latches. The mesh removable fence stair areas has gaps that is as wide as 2 inches which applicant will have the pool fence worker add mesh onto the areas.

Applicant also purchased a fully charged fire extinguisher size 3A40BC which meets the department's requirement and she has an EMSA approved pediatric CPR and First Aid cards that are valid through May 2024. .


The following item needs to be corrected prior to granting a license.
  • Add mesh onto the gaps that are more than 1 3/4 inch and submit pictures to LPA within 10 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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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