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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629200
Report Date: 11/01/2021
Date Signed: 11/01/2021 12:08:11 PM

Document Has Been Signed on 11/01/2021 12:08 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ALI, HABIBO FAMILY CHILD CAREFACILITY NUMBER:
376629200
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/01/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Habibo AliTIME COMPLETED:
10:15 AM
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On November 1st, 2021 at 9:50 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a capacity increase inspection. Licensee Habibo Ali was advised of the meeting’s purpose and she granted LPA facility entry. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present in the home was only the Licensee. This two (2) bedroom, two (2) bathroom apartment was toured and inspected. This downstairs apartment unit has two (2) floors. The daycare operational schedule is weekdays 5:30 AM to 2 AM.

On 10/19/2021, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 10/28/2021 for fourteen (14) children. Landlord consent is on file.

The off limits areas are the kitchen and top floor. The stairs to the second floor and the kitchen are made inaccessible to daycare children with safety gates. The following rooms are used for care: living room, and downstairs bathroom.

Licensee accompanied LPA on a tour of the home, as shown on the updated facility sketch. Background criminal record clearances were verified and discussed. First Aid and CPR certifications expire in September 2023. Facility has a working 2A10BC fire extinguisher, smoke alarms, and carbon monoxide detector. The last safety drill was on 09/03/2021. Licensee states there are no bodies of water on the premises and none were observed. Per the Licensee, neither weapons nor ammunition are stored on the facility premises.






SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ALI, HABIBO FAMILY CHILD CARE
FACILITY NUMBER: 376629200
VISIT DATE: 11/01/2021
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In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) of children is approved effective today 11/01/2021. A new license will be generated and mailed to the provider.

LPA provided the Licensee with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. Licensee posed this notice during this inspection. An exit interview was conducted with the Licensee Habibo Ali. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to the Licensee and their signature on this form confirms receipt of these rights.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC809 (FAS) - (06/04)
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