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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628583
Report Date: 05/26/2023
Date Signed: 05/26/2023 03:22:31 PM

Document Has Been Signed on 05/26/2023 03:22 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:CHEMSI, MOUNIA FAMILY CHILD CAREFACILITY NUMBER:
376628583
ADMINISTRATOR:MOUNIA CHEMSIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 988-6622
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mounia ChemsiTIME COMPLETED:
03:00 PM
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On 05/26/2023 at 02:30 PM, Licensing Program Analyst (LPA) Edgar Campana, conducted an unannounced case management visit to facility in order to deliver amended reports and to inspect a deficiency correction.

LPA met with Licensee Mounia Chemsi and discussed reason for visit. LPA toured the facility; there were no daycare children present. LPA observed that the hallway restroom on the first floor (daycare restroom) has been repaired - POC cleared.

No deficiencies issued during today's inspection. An exit interview was conducted with Licensee, Mounia Chemsi. A copy of this report and a Notice of Site Visit (LIC 9213) was provided to licensee. LPA informed licensee Notice of Site visit shall be posted for 30 days from today's date.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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