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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376628367
Report Date:
05/28/2024
Date Signed:
05/28/2024 11:56:11 AM
Document Has Been Signed on
05/28/2024 11:56 AM
- 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:
ADAM, MULKI FAMILY CHILD CARE
FACILITY NUMBER:
376628367
ADMINISTRATOR/
DIRECTOR:
MULKI ADAM
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(619) 321-7110
CITY:
SAN DIEGO
STATE:
CA
ZIP CODE:
92115
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
05/28/2024
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
11:13 AM
MET WITH:
Attempted
TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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SUPERVISORS NAME
:
Renesha Askew
LICENSING EVALUATOR NAME
:
Renita Rodriguez
LICENSING EVALUATOR SIGNATURE
:
DATE:
05/28/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/28/2024
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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