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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101083
Report Date: 03/17/2025
Date Signed: 03/17/2025 10:58:19 AM

Document Has Been Signed on 03/17/2025 10:58 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ALZERKANY, METHAK FAMILY CHILD CAREFACILITY NUMBER:
376101083
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 12CENSUS: 5DATE:
03/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Methak AlzerkanyTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On 3/17/25 at 10:30 am Licensing Program Analyst (LPA) Gerald Poindexter was conducting an inspection concerning another matter at the facility. LPA met with licensee Methak Alzerkany. There was a total of 5 children present, with one infant present. Licensee's adult son Alaa Al-Sudany was also present. LPA discussed with Ms. Alzerkany the details surrounding a 3/5/25 injury incident at the facility and the regulation related to that matter. LPA notes and the licensee acknowledges that this incident, which required medical attention to a child, was not reported to the Department by the facility with 24 hours. Ultimately, the licensee submitted a written LIC624B - Unusual Incident Report, to the Department on 3/14/25.

See LIC 809D for deficiency cited.

Exit interview conducted and report was reviewed with the licensee, Methak Alzerkany. A Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal rights were provided.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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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Document Has Been Signed on 03/17/2025 10:58 AM - It Cannot Be Edited


Created By: Gerald Poindexter On 03/17/2025 at 10:31 AM
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: ALZERKANY, METHAK FAMILY CHILD CARE
FACILITY NUMBER: 376101083

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2025
Section Cited
CCR
101212(d)(1)(c)

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Reporting Requirements: Upon the occurrence, during the operation of the child care center…(d)(1)…a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:
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LPA printed the reporting requirements regulation and provided it to Ms. Alzerkany, who stated she will ensure that any future incidents are reported to the duty line 619-767-2248 within 24 hours by phone and submitted within 7 days of the incident occurring via Unusual Incident
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Based on record review and information gathered during another matter, the facility did not report to the Department an injury incident on 3/5/25, which poses a potential health, safety or personal rights risk to persons in care.
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Report by email to SDIncidentReports@dss.ca.gov or by Fax at 619-767-2203. Ms. Alzerkany will also provide written statement to LPA at Gerald.Poindexter@dss.ca.gov by 3/24/25 explaining that she will submit future reports per the required time frames.

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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:Joelle Redding
LICENSING EVALUATOR NAME:Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2025


LIC809 (FAS) - (06/04)
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