414004778-4-14-2021-05-CC-AMEN-C23QKF-20210414121417

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004778
Report Date: 04/14/2021
Date Signed: 04/14/2021 12:14:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	BEGIYEVA, KHILOLA & SAFAYEVA, MALIKA		FACILITY NUMBER:	414004778
ADMINISTRATOR:	BEGIYEVA, KHILOLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 867-6250
CITY:	DALY CITY	STATE: CA	ZIP CODE:	94015
CAPACITY:	14	CENSUS:	DATE:	04/14/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Khilola Begiyeva		TIME COMPLETED:	12:25 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	Due to the COVID-19 pandemic, field visits are suspended at this time. Licensing Program Analyst (LPA) Andrea Medlin met with applicant via tele-inspection for a prelicensing visit due to a change of location. Applicant/Licensee acknowledges that the previously licensed location (Lic 384004068) will be automatically forfeited once this location is licensed. The North County Fire Department has approved the fire clearance on 4/8/2021 and received in the licensing office on 4/9/2021. Days and hours of operation: Monday-Friday 8:30AM-5:30PM. Applicant states she, adult daughter, adult son,, and one minor child reside in the home. Criminal record clearance is on file for all adults in the home. Applicant advised that any person 18 years of age or older who lives here, or provides any care and supervision to daycare children, shall have criminal record clearance on file. The entire home is inspected for health and safety hazards. This is a two level home. The first level has: kitchen, family room, dining room, living room, one bedroom, and one bathroom. The second level has: three bedrooms and two bathrooms. The entire second level is off limits and is gated at the stairs. The daycare areas will be on first level: family room, dining room, living room, bathroom, bedroom for napping only, and outside fenced backyard. The kitchen is off limits, however is child proofed and may be used with supervision as a pass through between daycare areas. The home has working smoke detectors, carbon monoxide (CO) detectors, and a fully charged fire extinguisher. First aid supplies are available. Applicant will use a separated area for isolation of ill/sick children until picked up by parent/guardian. Per applicant, there are no pets and no firearms or weapons in the home. No pools, spas, hot tubs, fish ponds, or similar bodies of water are present. Per applicant, she plans to purchase liability insurance for the child care. There are sufficient, age appropriate toys, and children's equipment available. Bathroom is clean and hazardous materials are inaccessible to children. Applicant advised to conduct emergency disaster drills at least once every six months and log the date and time of the drill. (continued on next page 809-C)

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BEGIYEVA, KHILOLA & SAFAYEVA, MALIKA	FACILITY NUMBER: 414004778
	VISIT DATE: 04/14/2021

NARRATIVE

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If applicant provides care to the 13th and 14th child, who must be school aged, parent/guardian notification and landlord consent is required. The following is required to be posted in a prominent accessible location in view of parents: Emergency Disaster Plan (LIC 610), Parent's Rights (LIC 995A), and License (once received).
This home meets the licensing requirements of a Large Family Child Care Home (FCCH) today and licensure is recommended and approved as of today, 4/14/2021. The current license (384004068) at a different location is forfeited.

This report is reviewed with applicant and a copy of this report must be made available for public review upon request. This report is provided to applicant through email.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea Medlin	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021

LIC809 (FAS) - (06/04)

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