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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625549
Report Date: 11/01/2023
Date Signed: 11/01/2023 04:22:08 PM

Document Has Been Signed on 11/01/2023 04:22 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:EDRISAVIFEYAH, MALIHA FAMILY CHILD CAREFACILITY NUMBER:
376625549
ADMINISTRATOR:MALIHA EDRISAVIFEYAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 705-9138
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
11/01/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Maliha EdrisavifeyahTIME COMPLETED:
04:30 PM
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On 11/01/2023 at 2:45pm, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced case management inspection. Upon arrival, LPA met with licensee who was at the living with four day care children including two infants. There were eight day care children including two infants napping in bedroom #1 supervised by helper Sanaz Aflaki. Facility is within staffing ratio during today's inspection.
The day care areas were inspected and all areas are within compliance. Licensee has a valid EMSA approved pediatric CPR and First Aid card that is valid through 09/30/2025 and she completed the online mandated child abuse training on 12/28/2022. Licensee was reminded that the online mandated child abuse training certificate must be renew every two years. Helper Sanaz Aflaki has the required measles and TDAP immunization and she completed the online mandated child abuse training on 09/03/2022 and it is valid for two years.

Facility has an operating carbon monoxide detector and smoke detector located in the living room and a fully charged fire extinguisher size 3A40BC located in the kitchen. Licensee stated that the home doesn't have any weapon or bodies of water.

LPA reviewed all 12 of the children's records today and all records are in ordered.

Facility is within substantial compliance no citation issue.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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