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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376628597
Report Date: 09/02/2025
Date Signed: 09/02/2025 05:34:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/26/2025 and conducted by Evaluator Jacqueline Macias
PUBLIC
COMPLAINT CONTROL NUMBER: 20-CC-20250826114316
FACILITY NAME:ADAN, MANIRA FAMILY CHILD CAREFACILITY NUMBER:
376628597
ADMINISTRATOR:MANIRA ADANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 757-0201
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:14CENSUS: 0DATE:
09/02/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Manira AdanTIME COMPLETED:
05:50 PM
ALLEGATION(S):
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Adults in the home are not Criminally Record Cleared
INVESTIGATION FINDINGS:
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On September 2, 2025 at 2:30 pm, Licensing Program Analyst (LPA) Jacqueline Macias conducted an unannounced complaint inspection regarding the above allegation. Upon arrival, LPA met with Licensee, Manira Adan. Also present was Licensee’s mother, Fariyo Omar, Licensee’s brother Libaan Adan, and Licensee’s sister, Ladan Adan. LPA discussed the purpose of the inspection, the complaint process, and was led on a tour of the facility. There were no daycare children present at the time of inspection.

LPA reviewed staff records for assistant and obtained a copy of facility roster.

During the course of the inspection, interviews were conducted with the Licensee and three (3) Adult residents residing in the facility. Licensee admitted that Adult (A1) has been residing in the home since August 26, 2025. A1 also confirmed that she has been residing in the facility since August 26, 2025 without a criminal background clearance.
Substantiated
Estimated Days of Completion: 30
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Jacqueline Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 20-CC-20250826114316
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ADAN, MANIRA FAMILY CHILD CARE
FACILITY NUMBER: 376628597
VISIT DATE: 09/02/2025
NARRATIVE
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Based on interviews conducted with Licensee, three (3) adult residents, Licensee’s own admission, and LPA’s observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22, Division 12 & Chapter 3,) is being cited on the attached LIC 9099D. A $500 civil penalty is being assessed. See LIC 421BG.

Licensee has been cited one Type A deficiency. See LIC 9099D.

LPA Jacqueline Macias informed licensee Manira Adan that this report dated September 2, 2025 documents one Type A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Jacqueline Macias informed the licensee Manira Adan to provide a copy of this licensing report dated September 2, 2025 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to parents/guardians of any newly enrolled child 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. LPA provided Licensee with the LIC 9224 form.

A copy of this report and a Notice of Site Visit (LIC 9213) was given to Licensee Manira Adan and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. LPA observed LIC 9213 was posted. Appeal Rights (LIC 9058) was provided. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Manira Adan.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Jacqueline Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 20-CC-20250826114316
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ADAN, MANIRA FAMILY CHILD CARE
FACILITY NUMBER: 376628597
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/03/2025
Section Cited
CCR
102370(d)(1)
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102370(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to... residing...in a licensed facility: (1) Obtain a California clearance...as required by the Department..
This requirement is not met as evidenced by:
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Licensee states she will submit to the department a completed LIC9163 for Adult #1. Licensee stated she willl write a written statement of her understanding of the Criminal Record Clearance regulation and how she will comply in the future. Licensee stated she will watch the CCLD resource video regarding Criminal Record Clearance and submit to SDCCRO by email by 09/03/2025.
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Based on interview and observation, the licensee did not comply with the section cited above by not ensuring Adult #1 (A1) who has been residing in the home for about one week, has not obtained criminal record clearance, which poses an immediate health, safety or personal rights risk to persons 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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Jacqueline Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
LIC9099 (FAS) - (06/04)
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