376100612-1-28-2021-51-CC-NDIZ-BXPQVS-20210128113048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100612
Report Date: 01/28/2021
Date Signed: 01/28/2021 11:31:24 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:	KOHISTANI, HABIBULLAH & PARWIN FAMILY CHILD CARE		FACILITY NUMBER:	376100612
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	01/28/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Habibullah & Parwin Kohistani		TIME COMPLETED:	11:30 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 1/28/21 at 10AM, Licensing Program Analyst(LPA) Nancy Diaz conducted an announced Pre-Licensing inspection for a change of location with applicants, Habibullah & Parwin Kohistani. Due to COVID-19 pandemic restrictions, this inspection was completed virtually via Zoom meeting. Mr. Kohistani translated this inspection in Pashto. This four-bedroom, three-bathroom two-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Applicant maintains smoke and carbon monoxide detectors and fire extinguisher in the home. Both detectors were tested today and deemed to be operable. All hazardous items were latched and secured under the kitchen and bathroom sink and are out of reach of children. Mr. and Mrs. Kohistani stated that they do not maintain any weapons in the home. There is a community swimming pool that is approximately 650 ft. away from the home. This pool is inaccessible to children via 5ft. fence. 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. Adults living in the home are: Habibullah Kohistani, Parwin Kohistani, their two adult daughters Lima & Arzo Kohistani. They have four minors living in the home (ages 7, 12, 16 & 17). Control of property was provided to the department via copy of mortgage statement. First Aid and CPR will expire on April 2021 and Preventative Health Practices course was completed on April 17, 2019. Lead Poisoning Prevention course was completed on January 5, 2021. Mandated Reporter Training was waived due to limited English proficiency of applicants. Applicant's spoken language is Pashto. The daycare children will have access to: living room, family room, dining, kitchen, downstair bathroon and back fenced yard. Off limit areas are: 2nd floor and garage. The yard is fully fenced (5 ft. wooden fencing). CONTINUED ON PAGES 2 & 3

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

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: KOHISTANI, HABIBULLAH & PARWIN FAMILY CHILD CARE	FACILITY NUMBER: 376100612
	VISIT DATE: 01/28/2021

NARRATIVE

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The new provider packet was reviewed with the applicant including information on child abuse reporting, children’s records, immunizations, adults living or working in the home, SIDS, Incidental Medical Services, and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed Shaken Baby Syndrome and California Megan's Law and LPA provided: www.meganslaw.ca.gov. Applicant submitted a COVID-19 self-assessment form.

Applicant and LPA discussed COVID-19 guidelines and how to prevent spread of the virus. Applicant has posted COVID-19 posters in facility. Applicant was provided COVID-19 resources and directed to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

Any minor upon his/her 18^th birthday must be fingerprinted within 30 days. Applicant has met all immunization requirements per SB792 and have completed the AB1207 Mandated Reported Training. Applicant is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

Both applicant stated that they will comply with all regulations and laws governing family child care homes and that they are financially secure to operate a family child care home for children. LPA reviewed this report with Applicant prior to obtaining her signature.

LPA discussed and provided applicant with the following: Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov and phone number (916) 654-1541.In addition, for common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

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: KOHISTANI, HABIBULLAH & PARWIN FAMILY CHILD CARE	FACILITY NUMBER: 376100612
	VISIT DATE: 01/28/2021

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

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website. Please go to www.ccld.ca.gov and click on Child Care, go under Quick Links and Quarterly updates, click on “Receive Important Updates” then enter your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

No corrections needed. License will be issued upon final review of the application.

The maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.

An exit interview was conducted with Mr. & Mrs. Kohistani . A copy of this report along with Appeal Rights (LIC9058) will be sent via e-mail to Mr. Kohistani. They will confirm receipt of these report via e-mail and the reply of confirmation will serve as the signatures acknowledging these rights.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

LIC809 (FAS) - (06/04)

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