<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101439
Report Date: 03/03/2025
Date Signed: 03/03/2025 01:40:47 PM

Document Has Been Signed on 03/03/2025 01:40 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:POLIS, RAIDA & BUTRUS, VIRJINYA FAMILY CHILD CAREFACILITY NUMBER:
376101439
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/03/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Virjinya Butrus & Raida PolisTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/3/25 at 10:50 AM, Licensing Program Analysts (LPAs) Keturah Lane and Hector Canton conducted an unannounced annual inspection with the Licensee. Co-Licensees also applied for capacity increase for a large family daycare. Upon arrival, LPAs met with Co-Licensees, Raida Polis and Virjinya Butrus and provided the Inspection Checklist (LIC126). The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present were both co-licensees, husband of Raida Polis (Nizar Oraha), Bashar Butrus (son of Raida and brother of Virjinya) and minor child/sibling. There were no daycare children at time of inspection. Co-licensees stated that the enrolled children are school-age and primarily attend the daycare after school hours. The fire extinguisher and carbon monoxide/smoke detector combo meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

LPAs 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 cannot 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. 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. LPAs observed no gaps that can allow the passage of a sphere with diameter of 4 or more inches. The gate swings away from the pool, self-closes and is self-latching. The self-latching gate has a key lockable device placed no lower than 60 inches above the ground. LPAs observed pool alarm functioning properly and meets ASTM International Standard F2208. LPAs observed a life ring with minimum diameter of 17 inches that was labeled approved by the United States Coast Guard, which was visible from the swimming pool and readily available. LPAs observed a rescue pole with a body hook that was 12 feet in length, visible from the swimming pool and readily available. (continued on LIC809-C...)
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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: POLIS, RAIDA & BUTRUS, VIRJINYA FAMILY CHILD CARE
FACILITY NUMBER: 376101439
VISIT DATE: 03/03/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPAs reviewed pool log (notebook) that co-licensees are checking the pool (alarm functioning) each day before providing care to children. Licensee agrees that fencing will remain in place and properly function whenever there are licensed children in care. LPA observed the pool to be appropriately fenced according to regulations and SB2866. Co-licensees agree that visual supervision is required at all times during outdoor play in backyard area.

Co-Licensees have provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include: living room, living room #2, kitchen and bathroom #1. Off limits areas include: garage, bedroom #1, bedroom #2 and bedroom #3 which includes a smaller bathroom #2 and are inaccessible through the use of door-knob covers and door locks. The home appears to be large enough to comfortably accommodate 14 children. Fire clearance was received on 12/17/24. The fireplace is screened. There is a working phone at the facility. The licensee has sufficient age appropriate, safe, toys and equipment available.

Co-Licensees requested to add the backyard patio area and side yard to the license. LPAs observed the area to be free of potential hazards. Co-licensee understands that visual supervision is required at all times in the backyard due to the swimming pool. Co-licensee can add the front yard as well, once the fencing is fixed. There is an opening in the fence in the front yard with no gate. Co-licensee stated she would send a picture to LPA once the front fence has been repaired. Verification of control of property is on file. Co-licensees own the home.

Co-Licensee (Raida Polis) First Aid and CPR certifications expire on March 2026 . Co-licensee Virjina Butrus First Aid and CPR certifications expired on 2/8/25. Co-licensees meet immunization requirements and have completed Mandated Reporter Training expiring on 3/19/25 for Virjinya Butrus and Raida Polis is exempt from requirements. Licensee maintains emergency records for children, however several records did not have the parent rights (LIC995A) form. Required documents are posted. LPA reviewed documentation of emergency drills and last (earthquake/fire) drill was conducted on 10/28/24.

(continued on LIC809-C...)
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: POLIS, RAIDA & BUTRUS, VIRJINYA FAMILY CHILD CARE
FACILITY NUMBER: 376101439
VISIT DATE: 03/03/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Lane directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

Co-Licensees was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with co-licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Co-Licensees were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/. (continued on LIC809-C...)

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: POLIS, RAIDA & BUTRUS, VIRJINYA FAMILY CHILD CARE
FACILITY NUMBER: 376101439
VISIT DATE: 03/03/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 809-D).

Once all corrections are made and proof is sent to licensing a license for 14 children may be granted upon final file review. Applicant understands that proof of corrections must be submitted to Licensing within 30 days or the application may be denied. Applicant agreed to comply with all regulations and laws governing family child-care homes.

Exit interview conducted and report was reviewed with the co-licensees, Raida Polis and Virjinya Butrus. Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

During the exit interview, the co-licensees Raida Polis and Virjinya Butrus, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 03/03/2025 01:40 PM - It Cannot Be Edited


Created By: Keturah Lane On 03/03/2025 at 01:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: POLIS, RAIDA & BUTRUS, VIRJINYA FAMILY CHILD CARE
FACILITY NUMBER: 376101439

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)(1)
Admission Procedures and Authorized Representatives Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or
authorized representative has received and read the LIC 995A. The bottom portion of this form
must be kept in the child’s file as proof that the parent or authorized representative has been
notified of his or her rights and received a copy of the Caregiver background Check Process, LIC
995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 5 out of 6 children's records reviewed, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2025
Plan of Correction
1
2
3
4
Co-licensees will e-mail completed LIC995A forms to LPA Lane by 3/10/25.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tashima Daniel
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2025


LIC809 (FAS) - (06/04)
Page: 5 of 6