376100139-1-24-2020-51-CC-TBLK-BL5VL2-20200124153110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100139
Report Date: 01/24/2020
Date Signed: 01/24/2020 03:31:31 PM

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: 1	DATE:	01/24/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Mariam Warshan		TIME COMPLETED:	03:45 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	Licensing Program Analyst (LPA), Tyra Block, conducted an unannounced inspection for a capacity increase with the applicant. Present were Adina and Zia Nooristani and their 1 yo daughter. The single story house was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher (3A40B:C) located near the entrance to the home, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water on the property. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant has obtained landlord consent to care for 14 children. The home appears to be large enough to comfortably accommodate 14 children. Fire clearance was granted on 12/11/19. First Aid and CPR certifications expire on 10/20. Licensee meets immunizations requirements and has completed Preventative Health Training. Applicant will be using the following rooms for childcare: Living Room, Kitchen, Bedroom #4, and Bath #2. The following areas will be off limits: Garage, Bedrooms #1,2,and 3, and Bathroom #1. They are made inaccessible through the use of door knob covers and child safety gate. The applicant has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. The following information was reviewed with the applicant: information on reporting requirements for suspected child abuse and unusual incidents, children’s records, immunizations, adults living or working in the home and related civil penalties, shaken baby syndrome, Safe Sleep Regulation/SIDS. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

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: 01/24/2020

NARRATIVE

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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.

No deficiencies are cited. No corrections are needed; a license for 14 will be issued after a thorough file review.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. LPA provided notice of site visit and observed it being posted at the facility.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

LIC809 (FAS) - (06/04)

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