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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625549
Report Date: 07/13/2023
Date Signed: 07/13/2023 12:14:29 PM


Document Has Been Signed on 07/13/2023 12:14 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:14CENSUS: 0DATE:
07/13/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Maliha EdrisavifeyahTIME COMPLETED:
12:25 PM
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On 07/13/2024 at 11:05am, a Non-Compliance Conference was held on this date at the San Diego North Child Care Regional Office, with Regional Manager (RM) Kimberly Hall, Licensing Program Manager (LPM) Tashima Daniel, Licensing Program Analyst (LPA) Selina Siao, Licensee Maliha Edrisavifeyah and Licensee's daughter/translator Kimie Parsa. The facility was licensed on 10/16/2015. Licensee also had a previous license from 01/10/2014 to 10/16/2015 at a different location for a capacity of 8 children.

LPA Selina Siao informed licensee, Maliha Edrisavifeyah that this report dated 07/13/2023, documents a Non Compliance Conference which shall be posted for 30 days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA Selina Siao informed the licensee, Maliha Edrisavifeyah, to provide a copy of this licensing report dated 07/13/2023 that documents any Non Compliance Conference (LIC9111) 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 of children 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.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023
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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