343624220-2-23-2022-03-CC-JGAG-CBWQ9T-20220223105853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624220
Report Date: 02/23/2022
Date Signed: 02/23/2022 10:59:08 AM

Document Has Been Signed on 02/23/2022 10:59 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	HOTAK, NASIMA		FACILITY NUMBER:	343624220
ADMINISTRATOR:	HOTAK, NASIMA		FACILITY TYPE:	850
ADDRESS:	2444 PARK ESTATES DRIVE		TELEPHONE:	(916) 583-3904
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	02/23/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nasima Hotak		TIME COMPLETED:	11:15 AM

NARRATIVE

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On Wednesday, February 23, 2022, at approximately 9:15 AM, Licensing Program Analysts (LPAs) Josiah Gathing & Alize Tillery met with Applicant Hotak, Nasima for the purpose of conducting an announced change of location pre-licensing inspection. During today's inspection, the applicant and five of her children were present in the home. Applicant’s first language is Pashto and her daughter provided translation during today’s inspection. The applicant, her husband, and two of her children are the only adults in the home, and all have criminal record clearances on file. Applicant plans to operate Monday-Friday from 6:00 AM to 10:00PM.

A health and safety inspection was conducted inside and outside the home. The single-story facility includes 3 bedrooms, family bathroom, kids bathroom, garage, living room, kitchen, play room, nap room, and back yard. Off limits areas include: All bedrooms, family bathroom, and garage.

There are two fireplaces in the home that were not covered. Toxic and hazardous items are inaccessible to children and out of children's reach. Sharp knives are stored in the kitchen out of children's reach. Applicant will have medications stored in an off limits area, out of children’s reach. A first aid kit, a functioning smoke detector, carbon monoxide detector and a full 2A10BC fire extinguisher were observed in the home. LPA observed all required licensing postings.

Applicant completed the Preventative Health and Safety course. Applicant has a current EMSA certified CPR and First Aid card which expires 12/026/2022. Applicant is exempt from the Mandated Reporter Training due to the language barrier. Applicant stated there are no weapons in the home and there are no bodies of water on the premises. Applicant understands that prior to making alterations or additions to the home or grounds,she shall notify the Department of the proposed changes.

Report continues on LIC809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: HOTAK, NASIMA	FACILITY NUMBER: 343624220
	VISIT DATE: 02/23/2022

NARRATIVE

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Applicant was encouraged to visit the Department’s website at www.cdss.ca.gov for more information regarding child care updates, forms, regulations and legislation. This report and a Notice of Site Visit was reviewed and provided to Licensee. Licensee acknowledges the Notice of Site Visit must be posted for 30 days.

LPAs discussed open door policy, supervisi, fire drills, children’s personal rights, reporting requirements, and the smoking prohibition with the applicant. A current roster of children enrolled muist be available and maintained for a period of here years, even after children are no longer in care.

Annual fees must be paid promptly and by the due date or late fees will be assessed. Applicant understands that the license is non-transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected.

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 submitting 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

LPA discussed the safe sleep regulations with Applicant 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 Director 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.

Report continues on LIC809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: HOTAK, NASIMA	FACILITY NUMBER: 343624220
	VISIT DATE: 02/23/2022

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An exit interview was conducted with Applicant and Covid-19 protocols were discussed. LIC311D, records, postings, and reporting requirements were discussed. LPA discussed personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Prior to receiving a license, applicant will provide the following to the LPA:

1. Photos showing barricaded fireplaces

LPA will also discuss the backyard fencing with manager and provide guidance to applicant before issuing the license.

Copy of this report was reviewed and provided to licensee. This report will be kept in the facility file and will be made available for public review upon request.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC809 (FAS) - (06/04)

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