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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100857
Report Date: 10/07/2021
Date Signed: 10/07/2021 11:45:19 AM

Document Has Been Signed on 10/07/2021 11:45 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:AL SAMMARIE, ZAINAB FAMILY CHILD CAREFACILITY NUMBER:
376100857
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/07/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Zainab Al SammarieTIME COMPLETED:
12:00 PM
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On 10/7/21 Licensing Program Analyst Michael Morales-DeSilvestore conducted an announced prelicensing visit to verify the applicants corrections. During the visit, LPA met with Zainab Al Sammarie.

LPA verified that the facility had all of the proper wall postings. LPA verified that the jacuzzi was locked from both sides and secured tightly. LPA verified that the fountain was filled with pebbles in a way that no standing water would accumulate.

A small family child care home license will be granted effective today, 10/7/21.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2021
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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