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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101439
Report Date: 04/28/2023
Date Signed: 04/28/2023 08:40:31 AM

Document Has Been Signed on 04/28/2023 08:40 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:POLIS, RAIDAI & BUTRUS, VIRJINYA FAMILY CHILD CAREFACILITY NUMBER:
376101439
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Raidi Polis and Virjinya ButrusTIME COMPLETED:
08:45 AM
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On 4/28/23 at 8:00 AM, Licensing Program Analyst (LPA) Keturah Lane, conducted a second announced pre-licensing inspection for relocation with the applicants. The purpose of today’s pre-licensing visit is to inspect the corrections made to the pool area, review the pre-licensing packet with applicants and answer any questions. Upon arrival, LPA met with Raidai Polis and Virjinya Butrus. Also present were Mary Butrus and Bashar Butrus.

LPA fully inspected the pool area and observed a mesh fencing installed that completely surrounds the pool, is 5 feet high, not climbable and is designed so children can not remove any portion of it. There is no direct access to any window or door. The mesh fencing is attached to the outer wood fence that separates the properties. The gate swings away from the pool, self-closes and is self-latching. LPA checked the entire mesh fence area and observed it is of sufficient strength to withstand the impact of toys and does not readily bend on impact. Licensee agrees that fencing will remain in place and properly function whenever there are licensed children in care. LPA observed the body of water (pool) to be appropriately fenced according to regulations.

LPA observed that all corrections needed to the pool prior to issuance of the license have been made. A license for 8 children may be granted upon final file review. Applicant agreed to comply with all regulations and laws governing family child-care homes. Exit interview conducted and report was reviewed with co-applicants Raidai Polis and Virjinya Butrus.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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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