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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376102184
Report Date: 06/05/2026
Date Signed: 06/05/2026 01:06:57 PM

Document Has Been Signed on 06/05/2026 01:06 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:AKBARI, ZUL QAIDA FAMILY CHILD CAREFACILITY NUMBER:
376102184
ADMINISTRATOR/
DIRECTOR:		ZUL QAIDA AKBARIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 654-8165
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 2DATE:
06/05/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Zul Qaida Akbari TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 6/5/26 at 9:20 AM, Licensing Program Analyst (LPA) Annette Sutherland conducted an unannounced annual inspection with the Licensee. Upon arrival, LPA met with Licensee Zul Qaida Akbari. Also present in the home were the licensee’s adult helper daughters, Sameya and Qaderia, the licensee’s adult son Muhammad, and two minor children. Sameya helped translate to Pashto. The two story home was toured and inspected to ensure an environment safe for the care and supervision of children. No day care children were present at the time of arrival. One day care child arrived at 12:08 PM and another shortly after. Licensee has provided adequate space for children to eat, sleep, and play within the home. Areas used for childcare include the family room, dining room, kitchen, living room, bathroom, and side porch. Off limits areas include the garage and the entire upstairs, which are made inaccessible through the use of a safety gate. The licensee has sufficient toys and equipment available. The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched, locked, and secured out of reach of children. There is a pool in the complex that meets regulations. Licensee stated there are no weapons in the home. First Aid and CPR certifications expire in 5/2027. Licensee has required immunizations. (Licensee is exempt from Mandated Reporter Training as their primary language is Pashto.) Children’s files were missing LIC 9150 Parent Notification of Additional Children in Care (See LIC 809D for citation issued). There were no staff records available for LPA review (See LIC 809D for citation issued). The facility roster was not completely filled out or updated (See Technical Violation issued). LPA observed required documents posted in an area accessible to parents/guardians.

Continued on LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Annette Sutherland
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/05/2026 01:06 PM - It Cannot Be Edited


Created By: Annette Sutherland On 06/05/2026 at 11:38 AM
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: AKBARI, ZUL QAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376102184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on the record review, the licensee did not comply with the section cited above and did not document the last fire drill, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Correction has been made and Licensee updated the last fire drill that was conducted on 3/1/26.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Annette Sutherland
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/05/2026 01:06 PM - It Cannot Be Edited


Created By: Annette Sutherland On 06/05/2026 at 11:38 AM
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: AKBARI, ZUL QAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376102184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above and did not have a fitted sheet for the crib, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee will purchase a fitted sheet for the crib, as she cares for multiple infants, by 6/12/26.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Helpers of the facility did not have mandated reporter training certificates, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 07/06/2026
Plan of Correction
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Licensee will have helpers complete the mandated reporter training and provide proof of certificates to the LPA by 7/6/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Annette Sutherland
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/05/2026 01:06 PM - It Cannot Be Edited


Created By: Annette Sutherland On 06/05/2026 at 11:38 AM
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: AKBARI, ZUL QAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376102184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, and helpers did not have immunization records, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee will submit proof to the LPA that helpers have immunization records by 6/12/26.
Type B
Section Cited
CCR
102370(k)
Criminal Record Clearance
(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above and did not have employee files for helpers, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee understands that employees/helpers must have complete files. Licensee will submit proof to the LPA by 6/12/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Annette Sutherland
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/05/2026 01:06 PM - It Cannot Be Edited


Created By: Annette Sutherland On 06/05/2026 at 11:38 AM
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: AKBARI, ZUL QAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376102184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Helpers/employees did not have preventative health training or CPR, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 07/06/2026
Plan of Correction
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Licensee understands that helpers/employees must have an employee file with all required forms and trainings
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above and did not have Employee Rights (LIC 9052) forms, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee understands that she must have employee files for all helpers and employees, and these files must include the LIC 9052 Employee Rights form.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Annette Sutherland
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2026


LIC809 (FAS) - (06/04)
Page: 6 of 10
Document Has Been Signed on 06/05/2026 01:06 PM - It Cannot Be Edited


Created By: Annette Sutherland On 06/05/2026 at 11:38 AM
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: AKBARI, ZUL QAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376102184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above and did not have immunization records for helpers/employees, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee will provide proof of immunizations for all helpers and submit it to the LPA by 6/12/26."If you'd like, I can help you finalize all POC statements in a clean list for your report.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above and did not have immunization records for all children in care, which poses a potential health, safety, or personal rights risk to persons in care
POC Due Date: 06/12/2026
Plan of Correction
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Licensee will provide proof of immunizations for children with missing records and submit it to the LPA by 6/12/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Annette Sutherland
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/05/2026 01:06 PM - It Cannot Be Edited


Created By: Annette Sutherland On 06/05/2026 at 11:38 AM
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: AKBARI, ZUL QAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376102184

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above and did not have sleep logs for all infants in care, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee will submit a sample of safe sleep logs for infants who did not have available sleep logs for review. Licensee understands that any child under 2 years old must have safe sleep logs available for LPA review.
Type B
Section Cited
HSC
1597.465(c)


This requirement is not met as evidenced by: The licensee notifies a parent that the facility is caring for two additional schoolage children and that there may be up to 13 or 14 children in the home at one time.
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Children’s files were missing the LIC 9150 Parent Notification of Additional Children in Care, which poses a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 06/12/2026
Plan of Correction
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Licensee must have parents complete and sign the bottom half of the LIC 9150 and place it in the child’s file. The completed top half of the form must be provided to the child’s parent. Licensee must submit proof to the LPA by 6/12/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Annette Sutherland
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2026


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 N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: AKBARI, ZUL QAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376102184
VISIT DATE: 06/05/2026
NARRATIVE
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Provider is reminded of the following: report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not permitted in day care. All equipment must be used only as intended by the manufacturer. LPA and Licensee discussed California Megan’s Law and LPA provided the website: www.meganslaw.ca.gov.A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer an existing clearance or exemption, prior to being present in a licensed Family Childcare Home. A civil penalty of $100.00 per day, up to $500.00 per day/per person, will be assessed if this regulation is violated. LPA discussed safe sleep regulations with the Licensee and provided the Child Care Licensing Safe Sleep webpage as an additional resource: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.LPA verified the licensee is conducting and documenting the required 15 minute checks. LPA was able to review some safe sleep logs; however, not all infants in care had current safe sleep logs (See LIC 809D for citation issued). LPA verified the Sleeping Plan (LIC 9227) was in the infant files. For general questions or questions regarding licensing requirements, the Licensee may contact the Child Care Licensing Duty Line at (619) 767 2248. Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Family Childcare Homes, Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Information regarding ADA was provided, including the US Department of Justice ADA Information Line at (800) 514 0301 (voice) / (800) 514 0383 (TTY) and the publication “Commonly Asked Questions about Childcare Centers and the ADA,” available at: http://www.ada.gov/childqanda.htm.See LIC 809D for deficiencies cited. Failure to make corrections will result in re-citation and/or civil penalties. An exit interview was conducted and the report was reviewed with the Licensee. During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS. A Notice of Site Visit was provided and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Annette Sutherland
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026
LIC809 (FAS) - (06/04)
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