376100555-5-4-2021-51-CC-SSAA-C2PN96-20210504101526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100555
Report Date: 05/04/2021
Date Signed: 05/04/2021 10:16:16 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:	ESMATI, KHATIMA & AZIM, MOHAMMAD FAMILY CHILD CARE		FACILITY NUMBER:	376100555
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	05/04/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Khatima Esmati		TIME COMPLETED:	10:15 AM

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 05/04/2021 at 9:45am, Licensing Program Analyst (LPA) Samantha Salunga conducted a unannounced Case Management virtual inspection via Face Time with Co-Licensee, Khatima Esmati, due to COVID-19. Licensee's have requested an increase of capacity from having 8 children to 14 children. Fire clearance was granted on 04/21/2021. Present at the home is Co-Licensee and her daughter. The following areas are used for childcare: living room, dining room, family room, kitchen and 1/2 bathroom located downstairs. The home has a fireplace that is blocked off with a fireplace screen. Off limit areas includes upstairs and there is a secured safety gate to prevent access. The attached garage is also off limits and is inaccessible with a doorknob cover. The home has a fully charged fire extinguisher, smoke and carbon monoxide detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children during the inspection. Co-Licensee, Khatima Esmati, stated that the home doesn't have any weapons or bodies of water. Outdoor area will be the fenced backyard and supervision is required when children are playing outside. All required postings are posted at the home including the COVID-19 related postings. Co-Licensee stated that her and her husband are the only adults residing in the home. Co-Licensee was reminded of requirements for children’s records, facility roster, child abuse and unusual incident reporting, immunization's, adults living or working in the home and associated civil penalties of $100 per day, car seat law, shaken baby syndrome and SIDS. Co-Licensee was reminded that corporal punishment, smoking, baby walkers, exersaucers, bouncy seats and baby jumpers are not allowed in day care. 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

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Salunga	TELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021

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: ESMATI, KHATIMA & AZIM, MOHAMMAD FAMILY CHILD CARE	FACILITY NUMBER: 376100555
	VISIT DATE: 05/04/2021

NARRATIVE

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Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at www.ccld.ca.gov. LPA discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

No deficiencies observed in the areas inspected during today's visit.

***Capacity increase of a large FCCH license is granted and effective today’s date, 05/04/2021.

LPA read the report to Co-Licensee during the tele-inspection. A copy of this report and Notice of Site Visit (NOSV) will be e-mailed to Co-Licensee's husband, Mohammad Azim, and Ms. Esmati is advised that acknowledgement of the receipt of the report is to be received from applicant within twenty-four hours. NOSV IS TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Salunga	TELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021

LIC809 (FAS) - (06/04)

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