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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101044
Report Date: 04/24/2024
Date Signed: 04/24/2024 04:10:18 PM

Document Has Been Signed on 04/24/2024 04:10 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:POLIZA, RAWAA FAMILY CHILD CAREFACILITY NUMBER:
376101044
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 2DATE:
04/24/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Licensee, Rawaa PolizaTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA), Saraliz Velando conducted an unannounced case management inspection for increase in capacity. LPA met with Licensee, Rawaa Poliza. There were 2 children present. This visit is to verify that the licensee remains in substantial compliance with the health & safety standards as required by regulations governing large family childcare homes. Licensee has all appropriate forms posted. LPA confirmed with licensee that all adults residing/working in the home have criminal record/TB clearances. The home appears to be large enough to comfortably accommodate 14 children. Fire clearance was granted on 3/29/24.

LPA toured the home. Licensee uses the following areas for childcare: guest house area including the play and sleep area, kitchen counter, dining area and bathroom. The home has a wall heater that has been sealed off and applicant does not plan on using the heater. Off limit areas includes the main house that has five bedrooms and two bathrooms, kitchen, living room and laundry room laundry room and garage. The off-limit areas have a separate entrance. Outdoor play area will be the enclosed patio by the day care room. The home has an operating smoke and carbon detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children during the inspection. Licensee stated she does not have any weapons and LPA did not observe any. Licensee has a pool with fence surrounding it and is five feet high and there is a door that swings away from the pool that self-latches. The body of water meets regulations.

Licensee’s Pediatric CPR/First Aid is valid through May 2024. Licensee has a Mandated Reporter Training certificate that expired January 2024.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: POLIZA, RAWAA FAMILY CHILD CARE
FACILITY NUMBER: 376101044
VISIT DATE: 04/24/2024
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LPA reviewed the following: required departmental documents, regulation highlights, community resources, capacity limitations, supervision, clearances, emergency drills, heat-related illness, child passenger law, unusual incidents, mandated reporting, Assembly Bill 633, SIDS, Safe sleep regulations, Shaken Baby Syndrome, Megan's law and Covid information. Applicant is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Any equipment used should only be used according to the manufacturer recommendations. For licensing regulations/updates/forms, go to webpage http://www.ccld.ca.gov

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

An exit interview was conducted with licensee, Rawaa Poliza.

No deficiencies were cited. A large license will be granted upon final file review. A notice of site visit was issued and shall remain posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC809 (FAS) - (06/04)
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