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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101490
Report Date: 05/08/2023
Date Signed: 05/08/2023 09:49:24 AM

Document Has Been Signed on 05/08/2023 09:49 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:AMIRI, BASMINA & EMAL FCCFACILITY NUMBER:
376101490
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
05/08/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Emal and Basmina AmiriTIME COMPLETED:
10:00 AM
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On 5/8/23 at 09:30 AM Licensing Program Analyst (LPA) Adrian Mangina conducted a Plan of Correction visit to the child care home to follow-up on corrections required during a change of location prelicening inspection conducted on 5/3/23. LPA met with Licensees Emal and Basmina Amiri. There were three minor children in care.

During the visit LPA verified that the following were completed:

1) Cover tree roots in back yard
2) Remove hazards from side yard
3) Post correct LIC999A Facility sketches for this address
4) Cover broken patio tiles in back yard

A small/large license for up to 8 children may be granted upon final file review. Exit interview conducted and report was reviewed with and provided to the licensees Emal and Basmina Amiri.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2023
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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