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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500616
Report Date: 01/17/2024
Date Signed: 01/17/2024 11:11:55 AM

Document Has Been Signed on 01/17/2024 11:11 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AWADALLA, MANALFACILITY NUMBER:
394500616
ADMINISTRATOR:MANAL AWADALLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(407) 810-9279
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
01/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Manal AwadallaTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Erwin Tjhia met with licensee, Manal Awadalla to deliver an amended version of a report created on 01/10/2024. There were 5 children present at today's inspection supervised by licensee.

Moreover, during today's inspection, licensee requested to add Facility's left side yard from off limits to on limits. LPA tour area and observe no hazardous items accessible for the children. On 01/17/2024 LPA will approve these area to be on limit area. Facility's off limit area are: Entire upstairs, living room, dining/coffee area, storage closet by the downstair bathroom, garage, and right side of the backyard.

No deficiencies were observed. An exit interview was conducted.

A Notice of Site Visit was posted and must remain posted for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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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