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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376625549
Report Date:
06/13/2023
Date Signed:
06/13/2023 02:20:48 PM
Document Has Been Signed on
06/13/2023 02:20 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:
EDRISAVIFEYAH, MALIHA FAMILY CHILD CARE
FACILITY NUMBER:
376625549
ADMINISTRATOR:
MALIHA EDRISAVIFEYAH
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(858) 705-9138
CITY:
SAN DIEGO
STATE:
CA
ZIP CODE:
92127
CAPACITY:
14
CENSUS:
26
DATE:
06/13/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:31 AM
MET WITH:
Maliha Edrisavifeyah
TIME COMPLETED:
02:30 PM
NARRATIVE
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On 06/13/2023 at 10:31 AM, Licensing Program Analyst (LPA) Selina Siao conducted an unannounced random inspection with the Licensee. The home was toured and inspected to ensure an environment safe for the care and supervision of children. Upon arrival there were 11 children in the living room with licensee and her helper Sanaz Aflaki and during the inspection LPA observed 16 more children at another room that leads to the side yard with helpers Leyla Peirovisangari and Shirin Arya. Facility has a total of 26 children including 9 infants and no school age children in care. The home has a fully charged fire extinguisher size 3A40BC, smoke and carbon monoxide detector that meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee stated that there are no bodies of water at the home and licensee stated that the home does not have any weapon. 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. Licensee and helpers Sanaz Aflaki and Leyla Peirovisangari has a valid pediatric First Aid and CPR certifications are valid through 09/25/2023. Licensee and helpers Sanaz Aflaki and Leyla Peirovisangari have completed the online mandated child abuse training and licensee was reminded that it must be renew every two years. Licensee and her helpers have the required measles and TDAP immunizations. Children’s records were reviewed and six of the children's files are not available as licensee stated that 9 of the kids in care are guest/drop in only. Facility's roster did not have all the children's name listed. Licensee last conducted a fire drill with the children in care on 04/28/2023 and a log is available for review. A copy of the facility's updated roster was obtained during today’s inspection.
Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room, bathroom and one bedroom. Licensee has been using the converted garage and another bedroom to care for the children without approval from the department. Licensee would also like to use the kitchen for young non mobile infants to be in the playpen while she is in the kitchen. Off limits areas include kitchen, dining room and the two bedroom upstairs, the off limit areas are inaccessible through use of a gate to prevent children's access. The facility has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities.
SUPERVISOR'S NAME:
Monica Cuddy
TELEPHONE:
(619) 767-2249
LICENSING EVALUATOR NAME:
Selina Siao
TELEPHONE:
(619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2023
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
8
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:
EDRISAVIFEYAH, MALIHA FAMILY CHILD CARE
FACILITY NUMBER:
376625549
VISIT DATE:
06/13/2023
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
The following items were discussed with provider: Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. Licensee was provided with information about Effects of Lead Exposure and safe sleep regulation.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at
https://www.cpsc.gov/
and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at
https://cdss.ca.gov/inforesources/community-care-licensing/subscribe
. LPA discussed California Megan's Law with provider and advised her to go on the website at
www.meganslaw.ca.gov
.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to
inspectionprocess@dss.ca.gov
. For additional information regarding the inspection and its tools and methods, please visit the
Program website
at
www.cdss.ca.gov/inforesources/community-care-licensing/nspection-process
.
SUPERVISOR'S NAME:
Monica Cuddy
TELEPHONE:
(619) 767-2249
LICENSING EVALUATOR NAME:
Selina Siao
TELEPHONE:
(619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2023
LIC809
(FAS) - (06/04)
Page:
2
of
8
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:
EDRISAVIFEYAH, MALIHA FAMILY CHILD CARE
FACILITY NUMBER:
376625549
VISIT DATE:
06/13/2023
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
See LIC809D for deficiencies and Technical violations attached.
“Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months
:
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee.
SUPERVISOR'S NAME:
Monica Cuddy
TELEPHONE:
(619) 767-2249
LICENSING EVALUATOR NAME:
Selina Siao
TELEPHONE:
(619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2023
LIC809
(FAS) - (06/04)
Page:
3
of
8
Document Has Been Signed on
06/13/2023 02:20 PM
- It Cannot Be Edited
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:
EDRISAVIFEYAH, MALIHA FAMILY CHILD CARE
FACILITY NUMBER:
376625549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/13/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(f)
Infant Safe Sleep
An infant shall not be swaddled while in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA Siao's observation today, the licensee did not comply with the section cited above in 1 out of 9 of the infant was observed to be swaddled which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
06/14/2023
Plan of Correction
1
2
3
4
Licensee stated that she now understands that swaddle is not allow at any licensed day care facility. Licensee stated that she will tell the parents that she cannot swaddle the baby while she is in care.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Monica Cuddy
TELEPHONE:
(619) 767-2249
LICENSING EVALUATOR NAME:
Selina Siao
TELEPHONE:
(619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2023
LIC809
(FAS) - (06/04)
Page:
4
of
8
Document Has Been Signed on
06/13/2023 02:20 PM
- It Cannot Be Edited
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:
EDRISAVIFEYAH, MALIHA FAMILY CHILD CARE
FACILITY NUMBER:
376625549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/13/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA Siao's observation, the licensee did not comply with the section cited above as LPA observed an exersaucer, nfant bouncer and baby walker in the converted garage that the facility has been using to care for infants. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/14/2023
Plan of Correction
1
2
3
4
Licensee stated that she will remove the prohibted items and she will send me pictures of the items being removed from her day care area. Licensee stated that she understands that she cannot use the prohibited items.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA Siao's observation, the licensee did not comply with the section cited above as licensee has been using the converted garage and another bedroom to care for the children prior to getting approval from the department. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/14/2023
Plan of Correction
1
2
3
4
Licensee stated that she now understands that she needs to get an approval from licensing before she uses any additional area for the day care children. Licensee will send an email to LPA on her understanding of this requirement.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Monica Cuddy
TELEPHONE:
(619) 767-2249
LICENSING EVALUATOR NAME:
Selina Siao
TELEPHONE:
(619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2023
LIC809
(FAS) - (06/04)
Page:
5
of
8
Document Has Been Signed on
06/13/2023 02:20 PM
- It Cannot Be Edited
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:
EDRISAVIFEYAH, MALIHA FAMILY CHILD CARE
FACILITY NUMBER:
376625549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/13/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 6 out of 26 children's files are not available for review as licensee stated that they are guest/drop in temporary basis. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/14/2023
Plan of Correction
1
2
3
4
Licensee stated that she understands that in the future when she cares for any children including a child that will only attend the faciltiy for one day or one hour, she will need to have their parent's complete the licensing required documents.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above as the facility roster did not have all the children in care listed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/13/2023
Plan of Correction
1
2
3
4
Licensee updated the facility roster to include the children's names besides the 9 guest/drop in children's information.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Monica Cuddy
TELEPHONE:
(619) 767-2249
LICENSING EVALUATOR NAME:
Selina Siao
TELEPHONE:
(619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2023
LIC809
(FAS) - (06/04)
Page:
6
of
8
Document Has Been Signed on
06/13/2023 02:20 PM
- It Cannot Be Edited
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:
EDRISAVIFEYAH, MALIHA FAMILY CHILD CARE
FACILITY NUMBER:
376625549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/13/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 6 out of 6 infants (under 12 months) did not have the individual sleeping plan LIC9227 in their files. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
1
2
3
4
Licensee stated that she will have the parents that are under 12 months complete the individual sleeping plan and that she will submit the completed froms to LPA Siao no later than 06/23/2023.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Monica Cuddy
TELEPHONE:
(619) 767-2249
LICENSING EVALUATOR NAME:
Selina Siao
TELEPHONE:
(619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2023
LIC809
(FAS) - (06/04)
Page:
7
of
8