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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101651
Report Date: 03/18/2025
Date Signed: 03/18/2025 01:14:05 PM

Document Has Been Signed on 03/18/2025 01:14 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ADIL, ZARGHONA FAMILY CHILD CAREFACILITY NUMBER:
376101651
ADMINISTRATOR/
DIRECTOR:		ZARGHONA ADILFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 558-9791
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 3DATE:
03/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Licensee, Zarghona AdilTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 3/18/25, Licensing Program Analysts (LPAs), Saraliz Velando and Hector Canton conducted an unannounced Annual inspection. LPA was greeted by licensee, Zarghona Adil and her husband/helper, Mohammad Adil. LPAs were granted entry after identifying themselves and disclosing the purpose of the visit. There were 3 children in care today.

Licensee uses the following areas for childcare: living room, bathroom #1 and bedroom #1. Off limit areas includes: kitchen, master bedroom, bathroom #2, laundry room and storage room that is in a detached building. The off-limit areas have safety latches and doorknob covers to prevent children's access. Outdoor play area is a fenced and enclosed front yard area.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Home is clean, orderly and has adequate ventilation. Children’s toys and play equipment are available and observed free of hazards. There is a working telephone/email address. All cleaning compounds, detergents, medications, and poisons are made inaccessible through latches, placed up on high surfaces, and off limit areas. Licensee states there are no firearms in the home and LPA did not observe any. There are no bodies of water either. There are no new adults living or working in the home over the age of 18 years. All adult residents have been fingerprint cleared. Pediatric CPR and First-Aid certificate expires September 2025 for Licensee and husband. Licensee is exempt from Mandated Reporter Training because she speaks mostly Pashto.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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 03/18/2025 01:14 PM - It Cannot Be Edited


Created By: Saraliz Velando On 03/18/2025 at 12:35 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: ADIL, ZARGHONA FAMILY CHILD CARE
FACILITY NUMBER: 376101651

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that licensee does not maintain an immunization record for Child #1 in care and this poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/01/2025
Plan of Correction
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Licensee stated that she will have parents of Child #1 provide proof of immunization records for the child file and also send the proof to the Dept by 4/1/25.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that Licensee does not maintain a file for Child #1 that has been in care for approximately 2 weekswhich poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/01/2025
Plan of Correction
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Licensee stated that she will put a child file together with the Emergency card and other documents required for Child #1 and send proof to the Dept by 4/1/25.
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:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: ADIL, ZARGHONA FAMILY CHILD CARE
FACILITY NUMBER: 376101651
VISIT DATE: 03/18/2025
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share Licensee or facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day / per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee or facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee for facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htmyour inspection experience. If you have any questions regarding the process or tools, please send them by email to: inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Deficiencies were cited on LIC890-D.

Exit interview was conducted and report was reviewed with Licensee, Zarghona Adil. Copy of report and Appeal Rights was given. A notice of site visit was posted and must remain for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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