376627837-1-19-2022-51-CC-TBLK-CATSBK-20220119124405

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627837
Report Date: 01/19/2022
Date Signed: 01/19/2022 12:44:14 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:	HABIBI, HASIBA FAMILY CHILD CARE		FACILITY NUMBER:	376627837
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	01/19/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:51 AM
MET WITH:	Hasiba Habibi		TIME COMPLETED:	12:55 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 1/19/22, Licensing Program Analyst (LPA), Tyra Block, conducted an unannounced Case Management inspection for the purpose of a capacity increase. LPA met with licensee, Hasiba Habibi. Present at the home with licensee was her husband, Hamidullah and minor child. No other children or adults were (except Cox Cable technician) present. The areas used for child care include sunroom, kitchen, bathroom #1, and living room. Off limits areas include garage and all bedrooms. Off-limit areas are inaccessible through use of doorknob covers. The licensee has sufficient toys and equipment available for children to use. The home also has a fenced backyard available for outdoor activities. Fire clearance was granted 12/15/21. There is sufficient space to accommodate up to 14 children. Licensee is aware that when serving more than 8 children a helper is required. LPA discussed with licensee requirements for helper and provided a checklist for documents that must be submitted and maintained in helper's file. LPA also discussed the following with Applicant: A large family day care home may provide care for up to 14 children, with an assistant present, if all of the following conditions are met: At least two of the children are at least six years of age. No more than three infants are cared for during any time when more than 12 children are being cared for. * The licensee notifies a parent that the facility is caring for two additional school-age children and that there may be up to 13 or 14 children in the home at one time including children under age 10 who live in the licensee's 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.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.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

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: HABIBI, HASIBA FAMILY CHILD CARE	FACILITY NUMBER: 376627837
	VISIT DATE: 01/19/2022

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.

No deficiencies were cited during today's visit and no corrections are required.

A large license for up to 14 children will be granted effective today.

A Notice of Site Visit was provided and observed being posted.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

LIC809 (FAS) - (06/04)

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