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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376102164
Report Date: 03/18/2025
Date Signed: 03/18/2025 04:36:54 PM

Document Has Been Signed on 03/18/2025 04:36 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 NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WAZIR, BAKHMALA & MIR AJAM KHAN, ABDALI FCCFACILITY NUMBER:
376102164
ADMINISTRATOR/
DIRECTOR:		BAKHMALA WAZIR & MIR AJAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 404-9743
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 14TOTAL ENROLLED CHILDREN: 39CENSUS: 0DATE:
03/18/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH: Bakhmala Wazir and Abdali Mir Ajam Khan TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 3/18/2025 at 4:00pm, Licensing Program Analysts (LPAs) Vicky Williamson and Mahjoba Mohsini conducted an unannounced case management inspection. LPAs met with Licensees, Bakhmala Wazir and Abdali Mir Ajam Khan and discussed the purpose of the inspection. There were no children present during the time of inspection. Days and hours of operation are Monday - Friday, 7:00am - 9:00pm.

LPAs' review of facility records determined that tuberculosis clearance for Licensees’ adult daughter Raqeeba Mir Ajam Khan were not available for review during time of inspection.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, deficiencies are being cited on the attached LIC 809D.

A Notice of Site Visit (LIC 9213) was given to Licensees, Bakhmala Wazir and Abdali Mir Ajam Khan and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. LPAs observed LIC 9213 was posted. Appeal Rights (LIC 9058) was provided. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted, and report was reviewed with Licensees, Bakhmala Wazir and Abdali Mir Ajam Khan.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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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Document Has Been Signed on 03/18/2025 04:36 PM - It Cannot Be Edited


Created By: Vicky Williamson On 03/18/2025 at 03:26 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: WAZIR, BAKHMALA & MIR AJAM KHAN, ABDALI FCC
FACILITY NUMBER: 376102164

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2025
Section Cited
CCR
102369(b)(9)

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(b) The applicant shall provide all of the following information...(9)Evidence of a current tuberculosis clearance, not more than one year prior to or seven days... for any adult in the home...
This requirement is not met as evidenced by:

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Licensees stated that they will ensure that a current tuberculosis clearance for their adult daughter is submitted to the Department no later than 3/28/2025.
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Based on interview, the licensee did not comply with the section cited above in that Licensees adult daughter did not have tuberculosis clearance available for review during time of inspection, which poses a potential health, safety, or personal rights risk to persons in care.
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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:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
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