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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100700
Report Date: 01/31/2022
Date Signed: 01/31/2022 04:37:03 PM

Document Has Been Signed on 01/31/2022 04:37 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:SHAMOON, WARDYAH FAMILY CHILD CAREFACILITY NUMBER:
376100700
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
01/31/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Wardya ShamoonTIME COMPLETED:
04:45 PM
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On 1/31/22 at 4:00 PM Licensing Program Analyst (LPA) Adrian Mangina conducted a Plan of Correction visit to the child care home to follow-up on deficiencies cited during a previous 10 day visit on 12/22/21. LPA met with Licensee Wardya Shamoon. Also in the home was Licensee's adult daughter Maryam Galo who provided translation, Licensee's minor child and two children in care. Proper ratios and supervision were observed

LPA verified the following deficiencies were corrected:

1) Licensee has provided current child roster
2) Licensee has complete child files for all children in care and those who disenrolled in past 3 years
3) Last disaster drill was conducted 12/28/21
4) licensee is documenting naps for infant in care (child does not nap while in the home)

No deficiencies were cited during this visit.

Licensee was provided with a copy of this report (LIC809). Their signature on this form is acknowledgement of receipt. A Notice of Site Visit (LIC9213)was provided and must be posted for 30 consecutive days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022
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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