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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100430
Report Date: 08/17/2021
Date Signed: 08/17/2021 04:51:27 PM

Document Has Been Signed on 08/17/2021 04:51 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:ORAHA, RAGHAD & YAQOOB, SALWAN FAMILY CHILD CAREFACILITY NUMBER:
376100430
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
08/17/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Raghad Oraha and Salwan YaqoobTIME COMPLETED:
05:00 PM
NARRATIVE
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On 8/17/2021 at 4:00 PM Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Case Management-Deficiencies visit. Licensees were present with one child in care. Proper ratios and supervision were observed.

During the inspection LPA toured the home, reviewed child files, and obtained child roster.

See 809D for deficiencies cited in accordance with Title 22 California Code of Regulations.

An exit interview was conducted with the Licensees. The Licensee was provided a copy of their appeal rights (LIC 9058) along with a copy of this the report (LIC809) their signature on this form acknowledges receipt of these rights. LPA observed LIC 9213 (Notice of Site visit) was posted during today's visit. Notice of Site Visit must remain posted for 30 days.

SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2021
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
Document Has Been Signed on 08/17/2021 04:51 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 08/17/2021 at 04:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ORAHA, RAGHAD & YAQOOB, SALWAN FAMILY CHILD CARE
FACILITY NUMBER: 376100430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited
CCR
102417(g)(8)

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102417(g)(8) Operation of a Famly Child Care Home: Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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Licnesee will provde LPA with an updated roster to reflect all 33 children in care no later than 9/17/2021. Licensee will call LPA when complete and LPA will conduct a plan of Correction Visit.
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This requirement was not met as evidenced by:

Licensee acknowledged that she did not update her roster to include 21 children that she has had in care from June 2021 through August 16, 2021 which poses a potential health and safety risk to children in care.
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Type B
09/17/2021
Section Cited
CCR102421(1)(a)

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The licensee shall maintain... each child's record for at least three years following termination of service to the child.
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Licnesee will provde LPA with child files for 21 children in care from June 2021 through August 2021 to reflect all 33 children in care, no later than 9/17/2021. Licensee will call LPA when complete and LPA will conduct a plan of Correction Visit.
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This requirement was not met as evidenced by:

Based on Licnesee statement and record review, Licnesee did not create files for 21 of 33 children she has had in care as required which poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2021


LIC809 (FAS) - (06/04)
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