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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300385
Report Date: 04/06/2023
Date Signed: 04/06/2023 10:34:10 AM

Document Has Been Signed on 04/06/2023 10:34 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MOHAMMED FAMILY CHILD CAREFACILITY NUMBER:
336300385
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
04/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Andrea MohammedTIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Sumayya Habeebulla made an unannounced visit to the facility for another purpose. Upon arrival LPA rang the doorbell of the facility and the door was answered by a male adult. LPA introduced herself and asked the male adult for Licensee Ms. Andrea Mohammed. LPA also asked him his name to which he stated “hold on” and closed the door and went inside. LPA waited for a few minutes and rang the doorbell again and Licensee’s daughter came to the door and informed LPA that the facility is not operating at this time and is only operating in the weekend. LPA stated the purpose of the visit and that entrance to the facility is required.

Upon entering the facility LPA informed the facility representative that any adults residing at the facility should be fingerprint cleared and associated to the facility. Facility Representative stated that Mr. Maceo Salano is her cousin and only came in the morning since there are no childcare children. Facility representative stated that he does not live at the facility.

An Exit Interview was conducted, A Notice of Site visit was given, and the Facility Representative understands that it must remain posted for 30 days

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
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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