376100139-10-7-2019-51-CC-BSYA-BGQQ9Y-20191007115907

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100139
Report Date: 10/07/2019
Date Signed: 10/07/2019 11:59:15 AM

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:	WARSHAN, MARIAM FAMILY CHILD CARE		FACILITY NUMBER:	376100139
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/07/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Mariam Warshan		TIME COMPLETED:	12:03 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 10/07/19 at 10:30 a.m. Licensing Program Analysts (LPAs) Brooke Sykora and Martha Malane conducted an announced Pre-Licensing inspection for the purpose of a change of location with applicant Mariam Warshan. The applicant's daughter, Adina Nooristani, was also present and assisted with translating in Dari. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This four bedroom, two bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. The hours of operation are Monday through Sunday 6:00 a.m. to 12:00 a.m. The applicant has not yet moved into the home and the home is not yet ready for operation. All poisons, detergents, cleaning compounds, and medicines are inaccessible to children in care and are located in off limits area with door locks and cabinet latches and secured out of reach of children. The smoke detector, located in the hallway outside of bathroom #2, and carbon monoxide detector, located in the living room, meet requirements and are operational. The fire extinguisher meets regulations, is full, and located in the kitchen. There are no bodies of water. There are no firearms or other weapons in the home. Pediatric CPR and First Aid certifications are valid through 02/2020. Preventative Health Practices course was completed on 02/18/18. Fireplace is screened. Primary telephone is a cell phone which is operational. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant rents the facility and has provided proof of control of property by way of a rental agreement. Applicant states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. Applicant has met all immunization requirements and is currently exempt from completing the Mandated Reporter Training as it is not yet offered in Dari or Farsi. LPA and applicant discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. Applicant will use the entire home child care. The fully fenced backyard will be used for outdoor play.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke Sykora	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WARSHAN, MARIAM FAMILY CHILD CARE	FACILITY NUMBER: 376100139
	VISIT DATE: 10/07/2019

NARRATIVE

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The garage is inaccessible through the use of door knob covers and key locks.

The New Provider Resource Packet was reviewed with the applicant including information on safe sleep, shaken baby syndrome, liability insurance, health and nutrition handout, lead exposure information, tax resources, child abuse reporting, community resources, children’s records/facility records/required postings, immunizations, unusual incident report, facility roster, visual for ratio/capacity, prohibited items handout (walkers, exersaucers, jumpers and bouncy seats), emergency drill log example, and the YMCA Resource Center information.

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.htm.

The maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home. It should be noted that Landlord Consent for a capacity of eight children was received. Maximum capacity for the family child care home was discussed with the applicant.

Applicant was reminded that corporal punishment and smoking are not allowed in the day care. The applicant was also reminded that all items that read “keep out of reach of children” must be made physically inaccessible to children in care, all equipment that is used should be used only as intended by the manufacturer, and that all adults living or working in the home must obtain a fingerprint clearance/association prior to living or working in the home.

Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke Sykora	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WARSHAN, MARIAM FAMILY CHILD CARE	FACILITY NUMBER: 376100139
	VISIT DATE: 10/07/2019

NARRATIVE

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Southern California Child Care Advocate information was provided and applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The applicant has not yet moved into the home. A second inspection will need to be conducted prior to a license being issued. An exit interview was conducted and a copy of the report was provided to the applicant.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke Sykora	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

LIC809 (FAS) - (06/04)

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