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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376102915
Report Date: 04/01/2026
Date Signed: 04/01/2026 04:23:05 PM

Document Has Been Signed on 04/01/2026 04:23 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:ABDULRHMAN, KHADIJA FAMILY CHILD CAREFACILITY NUMBER:
376102915
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 1DATE:
04/01/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Khadija AbdulrhmanTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On 4/1/26 at 10:50 am, Licensing Program Analyst (LPA), Mahjoba Mohsini conducted an unannounced Case Management licensee initiated inspection with licensee, Khadija Abdulrhman. Present at the home was licensee’s minor child and Licensee’s husband Omar Dukhan who is also the facility helper. LPA Mohsini informed licensee that the purpose of the inspection was for the requested change of capacity. Licensee led LPA on a tour of the facility. Hours of operation are Monday through Sunday 7:30am – 12:00midnight.

Licensee states fire inspection was conducted on 3/26/2026 and as of today, a fire clearance has not been receive. Licensee is adding bedroom #2 to use for child care. Child care areas are: living room, dining room, bedroom #2, bathroom and kitchen. Off Limit areas are: bedroom #1 and backyard and are inaccessible by use of safety gates, safety latches or doorknob covers. There is no fireplace on the premises. Licensee utilizes the nearby park (Bill Beck Park) for out door activities with visual supervision at all times. Licensee stated there are no weapons and no bodies of water at the facility.
There are sufficient age appropriate toys, games, and play equipment available. The home was clean and orderly during inspection. Detergents, cleaning compounds, and inaccessible to children in care and poisons are to be locked away. LPA observed medicine at accessible in child care area. The fire extinguisher is rated 2A:10B:C and located in the dining room, smoke alarm and carbon monoxide detectors meet requirements and are operational. There is a working cell phone in the home. Licensee stated there are no firearms, other weapons or ammunition on the property.
Licensee maintains documentation of proof of control of property for review by the Department. Property Owner/Landlord Consent form LIC9149 is on file. Licensee’s Mandated Reporter is valid to 2/2027. Pediatric CPR and First Aid certifications expire are valid to July 2027. Immunization records are needed for the facility helper. Required documents are posted.
NAME OF LICENSING PROGRAM MANAGER: Keturah Lane
NAME OF LICENSING PROGRAM ANALYST: Mahjoba Mohsini
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2026
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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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: ABDULRHMAN, KHADIJA FAMILY CHILD CARE
FACILITY NUMBER: 376102915
VISIT DATE: 04/01/2026
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. 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: http://www.ada.gov/childqanda.htm

The maximum capacity for a Large Family Child Care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there is no qualified assistant, 14 years of age or present, the capacity reverts to the requirements for a Small Family Child Care.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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.

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 their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Type A deficiency was cited on the accompanying LIC 809D.
NAME OF LICENSING PROGRAM MANAGER: Keturah Lane
NAME OF LICENSING PROGRAM ANALYST: Mahjoba Mohsini
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/01/2026 04:23 PM - It Cannot Be Edited


Created By: Mahjoba Mohsini On 04/01/2026 at 11:57 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: ABDULRHMAN, KHADIJA FAMILY CHILD CARE
FACILITY NUMBER: 376102915

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/01/2026
Section Cited
CCR
102417(g)(4)

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102417 Operation of a Family Child Care Home (g) The home shall be free from... (4) Poisons, detergents, cleaning compounds, medicines... shall be stored where they are inaccessible to children. This requirement was not met as observed by:
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The Licensee, Khadija removed medication immediately from the Livingroom floor and states she will ensure medication will be inaccessible and out of reach from children in the future.
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Based on LPA observations, a bottle of medication was on the livingroom floor, accessible to daycare children which posed/poses an immidiate health, safety and personal rights risk to children 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.
Keturah Lane
NAME OF LICENSING PROGRAM MANAGER:
Mahjoba Mohsini
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/01/2026


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: ABDULRHMAN, KHADIJA FAMILY CHILD CARE
FACILITY NUMBER: 376102915
VISIT DATE: 04/01/2026
NARRATIVE
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Also, LPA Mahjoba Mohsini informed the Licensee, Khadija Abdulrhman to provide a copy of this licensing report dated 4/1/26 that documents Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Proof of corrections needed:
  • Facility helper's Immunizations (MMR and TDP) and proof of fire clearance from fire department.

LPA Mohsini informed Licensee, Khadia Abdulrhman that this report dated 4/1/26 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Exit interview was conducted with the Licensee Khadija Abdulrhman and report was provided, Appeals Rights were discussed and provided. A notice of site visit was provided and is to remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Keturah Lane
NAME OF LICENSING PROGRAM ANALYST: Mahjoba Mohsini
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2026
LIC809 (FAS) - (06/04)
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