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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624211
Report Date: 02/06/2025
Date Signed: 02/06/2025 01:22:35 PM

Document Has Been Signed on 02/06/2025 01:22 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PERVIN, NAHIDAFACILITY NUMBER:
343624211
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Nahida PervinTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 02/06/2025, Licensing Program Analyst (LPA) Soleil Marx met with Licensee, Nahida Pervin, for the purpose of conducting an unannounced annual inspection. The purpose of today's inspection was explained. LPA observed a census of six children in care being supervised by the licensee. Facility hours of operation are Monday through Friday 08:30 AM to 05:30 PM.

A health and safety inspection was conducted in the areas accessible to children. Off-limits areas include: entire upstairs and garage. Licensee understands that children may never enter off-limit areas. LPA observed the off-limit areas of the home were inaccessible by closed/locked doors, baby gate, and supervision. LPA observed a working telephone, dual functioning smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher within the home. LPA observed home was sanitary, safe, and orderly. LPA observed that hazardous items: detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care, are properly stored out of children's reach. LPA observed a variety of age-appropriate toys, equipment, and materials available to children within the home. LPA observed fireplace is barricaded with screen and glass cover and stairs are barricaded by baby gate. LPA made observations of Licensee interactions with children in care and observed supervision and personal rights regulations being followed by the Licensee. LPA verified ages of children during file review to ensure ratio/capacity were adhered to. Licensee stated there are no poisons, weapons/firearms, or bodies of water on the premises. Licensee understands that if there are any poisons in the home, all poisons must be locked with a key lock or combination lock.

LPA reviewed facility, staff, and children's records. LPA observed all required postings were posted and visible to authorized representatives. LPA observed a complete children's roster maintained and a fire drill log with drills being conducted and documented at least every six months. The last fire drill was conducted 06/2024. LPA reviewed records of children’s files and verified all files contained the required licensing forms. LPA reviewed records of Licensee file and verified it contained the required licensing forms/documentation. LPA verified Licensees have current EMSA approved pediatric CPR/First Aid training, which expires 03/2025. LPA verified licensees have current Mandated Reporter Training, which expires 03/2026. Licensee understands both CPR and mandated reporter training's’ must be completed every two years.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PERVIN, NAHIDA
FACILITY NUMBER: 343624211
VISIT DATE: 02/06/2025
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LPA observed safe sleep practices were being adhered to and LPA observed 15 minute sleep checks being conducted and documented for all children under 2 years old. LPA discussed the safe sleep regulations with the licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA 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.

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

During today’s inspection, LPA determined the facility to be in compliance with Title 22 Regulations. No deficiencies were cited in the areas evaluated. During the exit interview, the licensee, Nahida Pervin, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS prior to the inspection. Exit interview conducted and report was reviewed with the licensee. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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