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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629120
Report Date: 10/15/2021
Date Signed: 10/15/2021 10:43:44 AM

Document Has Been Signed on 10/15/2021 10:43 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:AH SING, EMMA FAMILY CHILD CAREFACILITY NUMBER:
376629120
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
10/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Emma Ah SingTIME COMPLETED:
11:00 AM
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On 10/15/21 at 10:20am, Licensing Program Analyst (LPA), Martha Malane, conducted an unannounced Case Management follow-up inspection. Upon arrival, LPA disclosed the purpose of the inspection and was led on a tour of the facility by Licensee, Emma Ah Sing. Also present during today’s inspection was homeowner, Theodore Shank. During this inspection there were three (3) children in care. Hours of operation are Monday through Friday 8:00am to 1:00pm.

No deficiencies issued during today's inspection. An exit interview was conducted with Licensee, Emma Ah Sing. A copy of this report, Appeal Rights and Notice of Site visit were provided to licensee.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2021
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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