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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700288
Report Date: 12/07/2022
Date Signed: 12/07/2022 02:48:04 PM

Document Has Been Signed on 12/07/2022 02:48 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BAWAZIR, ABDULLAHFACILITY NUMBER:
015700288
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
12/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:36 PM
MET WITH:Abdullah BawazirTIME COMPLETED:
03:47 PM
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On Dec 7, 2022 Licensing Program Analayst Sidney Cortez conducted a case management visit for Abdullah Bawazir. Present on this visit is the licensee, and 3 pre school age children. Licensee wanted technical advice if he wanted to increase capacity, and in depth instructions regarding covid 19 guidelines, safe sleep procedures, and review of forms and documents needed for operations.


Licensee wanted advice regarding his on limit areas, and current physical plants; and supervision guidelines. LPA Cortez advised licensee that he will need to get fire clearance, and get form 850 be sent out by the office.

LPA Cortez advised that he needed to review the PINs that gets updated on the CCLD website. It was reminded that First Aid and CPR Training and Mandated Reporter needs to be renewed every 2 years.
Exit interview conducted. Notice of site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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