<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101003
Report Date: 01/24/2023
Date Signed: 01/24/2023 02:39:31 PM

Document Has Been Signed on 01/24/2023 02:39 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:WAZIR, BAKHMALA & MIR AJAM KHAN, ABDALI FCCFACILITY NUMBER:
376101003
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
01/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Licensee Abdali Mir Ajam KhanTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/24/2023 @ 2:20 p.m., Licensing Program Analyst, Joelle Redding, made an unannounced visit for a requested increase in capacity. Fire clearance was granted on 1/17/2023.

LPA inspected the facility and reviewed the Child Care Roster, children and staff files.

Capacity limitations were discussed and a handout provided. Licensees understands that if they do not have an assistant present, they must operate at a small family capacity and that all assistants are to be fingerprint cleared and associated, have a negative TB test on file and proof of immunization for Measles, Pertussis and Influenza.

An assistant may not be left alone with children without current EMSA certified, pediatric First Aid/CPR certification. Licensees have enrolled in a recertification course with A-B-Cpr on 2/5.

Upon final file review, the request for increase in capacity is approved and an updated license will be mailed for posting.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1