Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376612449
Report Date: 03/07/2017
Date Signed: 03/07/2017 02:47:39 PM

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:PASHA, HANA I FAMILY CHILD CAREFACILITY NUMBER:
376612449
ADMINISTRATOR:PASHA, HANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 442-7521
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:14CENSUS: 5DATE:
03/07/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Hana PashaTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Yolanda Baez, made an unannounced visit for the purpose of an annual inspection. During this visit there were 5 children in care (2 infants and 3 toddlers). LPA Baez met with Licensee, Hana Pasha.

LPA Baez toured the home. The primary child care area is the living room and dining room area near the front door, the play room (room located near the front door), the living room (near the back sliding doors), the kitchen, and one bathroom located near the hallway. The entire upstairs is kept off limits (which includes 4 bedrooms and 1 bathrooms) as well as the downstairs master bedroom and the master bathroom. There are a sufficient amount of age appropriate toys, games and books available. The home has plenty of space for the children to eat, sleep and play, and was a comfortable temperature during this visit. The backyard is fully fenced and used for outdoor activities. The fire extinguisher is full, of regulation size, and located in near the kitchen area. The fireplace has been made inaccessible through the use of a gate. The stairs have been gated. The smoke alarm and CO2 monitor are operational. LPA Baez verified a working telephone and all required forms are posted. Licensee stated that there are not any firearms or ammunition on the property. There is a swimming pool located on the property and it has the proper fencing and self latching gate requirements as required by CCL regulations. LPA Baez verified that all adults living or working in the home have been fingerprint cleared and associated. LPA Baez reviewed children's files, child care roster, and emergency drill log. The last emergency drill was conducted on 09/2016. Licensee's pediatric CPR/FA certification is valid thru 10/31/17.

SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: 619-767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


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: PASHA, HANA I FAMILY CHILD CARE
FACILITY NUMBER: 376612449
VISIT DATE: 03/07/2017
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Baez reviewed physical plant, bodies of water, storage of hazardous items, Shaken Baby Syndrome, SIDS, emergency drills and child care roster. Incidental Medical Services were discussed. LPA reminded Licensee that walkers, jumpers, exersaucers and bouncers are not permitted for use in the day care.

IMS was discussed. The following information regarding ADA was provided, US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and http://www.ada.gov/childqanda.htm

*** New immunization law (SB792) was discussed with Licensee. Licensee understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Licensee has provided proof of immunization against Pertussis, Measles, and Influenza.

No deficiencies were cited throughout today's inspection.

NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed licensee post notice of site visit.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov

Duty Line: (619) 767-2248, Open Monday thru Friday 8am-5pm

SUPERVISOR'S NAME: Debbie HanesTELEPHONE: (619) 767-2205
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: 619-767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2