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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101240
Report Date: 09/30/2022
Date Signed: 09/30/2022 10:49:53 AM

Document Has Been Signed on 09/30/2022 10:49 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:YOUNAN, KHLOUD FAMILY CHILD CAREFACILITY NUMBER:
376101240
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
09/30/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Applicant Khloud YounanTIME COMPLETED:
10:55 AM
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On 9/30/2022, @10:40 a.m., Licensing Program Analyst, Joelle Redding, made an announced visit to inspect pool fencing as required during the prelicensing visit on 9/27/22.

LPA noted that the fencing installed is 5', black iron, with a self-latching gate opening outward, no more than 2" above the ground, with no more than 4" gaps between the bars and is surrounding the entire pool with no egress from the windows of the home.

The application for a change of location is granted and a license will be sent for posting.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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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