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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101518
Report Date: 06/02/2023
Date Signed: 06/02/2023 10:53:21 AM

Document Has Been Signed on 06/02/2023 10:53 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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:EL QASS BOUTROS, HALA FCCFACILITY NUMBER:
376101518
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 0DATE:
06/02/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee, Hala El Qass BoutrosTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA), Saraliz Velando conducted a prelicensing inspection for a change of location. LPA met with Licensee, Hala El Qass Boutros. Her husband, Rafid Yaqouna was also present. No daycare children were present.

LPA toured the home. It is a one level 3 bedroom, and 2 bathroom home. Licensee will be using the following areas for day care: Living room 1, Dining room, Kitchen, Bedroom 1, Bathroom 1, and Garden. Off-limits areas consist of: Bedroom 2 & 3, Bathroom 2, Front Yard, Pool, and Garage. There is a fireplace in the Off Limits Living Room 2 area that has been screened to be inaccessible to children. Licensee has a pool in the Off Limits Back yard area that is fenced and gated to meet Title 22 regulations. Licensee states that there are no weapons or ammunition in the home and LPA did not observe any. The fire extinguisher size (2A10BC) meets requirements and is fully charged and is located in the kitchen area. The smoke detector and carbon monoxide detector are located in the hallway area, meet department requirements, and are both functional.
Licensee’s Pediatric CPR/First Aid is valid through April 2024. Mandated Reporter Training expires March 2025. All adults living or working in the home have been fingerprint cleared and associated and immunization requirements have been met. Outdoor play area is fully fenced and equipped with age-appropriate play equipment and toys.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: EL QASS BOUTROS, HALA FCC
FACILITY NUMBER: 376101518
VISIT DATE: 06/02/2023
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When any IMS is provided, an updated Plan of Operation that includes 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.

Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.

No deficiencies are cited. Applicant agrees to comply with all regulations and laws governing Family Child Care Homes. A license for eight (8) will issued upon final review.
Exit interview was conducted and report was reviewed with licensee, Hala El Qass Boutros.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
LIC809 (FAS) - (06/04)
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