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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629427
Report Date: 09/22/2022
Date Signed: 09/22/2022 03:49:17 PM

Document Has Been Signed on 09/22/2022 03:49 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:HAMIDI, SAMIRA FAMILY CHILD CAREFACILITY NUMBER:
376629427
ADMINISTRATOR:SAMIRA HAMIDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 990-5086
CITY:CHULA VISTASTATE: CAZIP CODE:
91915
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Samira HamidiTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Edgar Campana conducted an announced prelicensing inspection with applicant, Samira Hamidi.  The applicant's spouse, Ahmad Hamidi, assisted with translating.  Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes.  This two story, three bedroom, three bath house was toured and inspected. 

LPA confirmed the following:
  • Hazardous items on east side of house have been made inaccessible to children in care
  • Plants with thorns have been made inaccessible to children in care
  • Hazardous items in upstairs cabinet and bathroom have been made inaccessible to children in care
  • Carbon Monoxide detector has been installed
  • Barricades have been installed at the bottom and top of staircase


A Regular Large Family Child Care Home license may be issued upon final file review.

Exit interview conducted and report was reviewed with the applicant, Samira Hamidi.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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