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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623120
Report Date: 01/22/2024
Date Signed: 01/22/2024 11:15:44 AM

Document Has Been Signed on 01/22/2024 11:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MAJID, SIMAFACILITY NUMBER:
343623120
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
01/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sima MajidTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the licensee, Sima Majid, for a case management. The applicant applied for a capacity increase from eight children in care to 14 children in care. The department sent the inspection request to the local fire department.

During today's inspection, LPA inspected the facility for health and safety of children. LPA observed the licensee has required documents posted next to the entrance. Licensee is using child protective gates on stairs and toward kitchen to keep off limit areas inaccessible. Per licensee, there are firearm or weapon in the house. All chemicals or other hazardous items are stored in off limit areas and are inaccessible for the children. The house has fully charged fire extinguisher, smoke alarm, carbon monoxide detector and working phone on site. During inspection, Licensee informed the LPA that the fire department has scheduled the inspection on January 24, 2024. LPA discussed the capacity and ratio requirements of a large license and a handout was provided. LPA also discussed the sleep regulations, keeping stairs inaccessible and prohibited items for the child care homes.

During today's inspection, LPA did not observe any hazard in the house. LPA informed the licensee that license for large license will not approved until the Department receive the approval from local fire department. Copy of this report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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