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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624357
Report Date: 07/27/2026
Date Signed: 07/28/2026 01:13:05 PM

Document Has Been Signed on 07/28/2026 01:13 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:SAFI, KARISHMAFACILITY NUMBER:
343624357
ADMINISTRATOR/
DIRECTOR:		KARISHMA, SAFIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(279) 229-6828
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 14TOTAL ENROLLED CHILDREN: 18CENSUS: 2DATE:
07/27/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Karishma SafiTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On Monday, July 27, 2026, Licensing Program Analyst (LPA) Tanya Washington conducted an unannounced annual/random inspection and met with the Licensee's sister Tamana Safi. LPA observed two daycare children in care of Tamana Safi, the Licensee was not present upon arrival. Facility hours of operation are Monday- Friday from 8:00 AM to 9:00 PM. Tamana called Licensee Karishma and informed her of LPA's inspection, she arrived to the facility at 2:10 PM. LPA was assisted by Pashto Interpreter #98473367, Mohammad.

LPA and Tamana toured all areas of the home accessible to children. Off-limit areas include: entire second floor and laundry room. When Licensee returned she acknowledged that children may never enter these off-limits areas.

LPA conducted a health and safety inspection and observed two kitchen knifes accessible in a lower kitchen cabinet. Tamana tossed one of the knifes on top of the upper kitchen cabinet, LPA advised her that it wasn't a safe practice to do so, she placed the other knife in the upper kitchen cabinet. LPA observed the required documents were posted where visible to parents. LPA observed an infant asleep in a play pen with two loose blankets, baby bottle and two plastic gloves inside the play pen. LPA observed one plastic laundry basket filled with toys and some stuffed animals in another playpen. There is no fireplace in the facility. The fire extinguisher appeared to be in working condition and accessible. LPA observed the smoke and carbon monoxide detectors are properly functioning. The licensee acknowledged that in areas that are not fenced, 100% supervision is required. Per Licensee there are no weapons in the facility. Per Licensee there are no poisons on the premises. There is a pool on the premises of the apartment complex which is fenced according to Title 22 Regulations.

LPA observed a children's roster, however it was not updated. LPA observed that the last fire drill was documented 11/22/2024. Licensee did not have complete files for the children who were present during today's inspection. Licensee's CPR and First Aid certification expired 10/2025 and her sister who was present alone with children did not have a certification. Licensee is exempt from Mandated Reporter Training due to language barrier.

PAGE 1. REPORT CONTINUES ON LIC809-C

Amanda Blesi
Tanya Washington
DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2026
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 10
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 10
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: SAFI, KARISHMA
FACILITY NUMBER: 343624357
VISIT DATE: 07/27/2026
NARRATIVE
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The 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.

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-and-resources/safe-sleep as an additional resource. LPA also 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. LPA did not observe a safe sleep log for an infant who was in care.

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/.



The 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.

Report Continued on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Tanya Washington
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC809 (FAS) - (06/04)
Page: 3 of 10
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: SAFI, KARISHMA
FACILITY NUMBER: 343624357
VISIT DATE: 07/27/2026
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days. The following citations are issued on following LIC809D pages. A civil penalty in the amount of $500.00 is assessed for 0 tolerance violation of regulations.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC 9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.

Exit interview conducted and report was reviewed with the licensee Karishma Safi. During the exit interview, the Licensee Karishma Safi, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Appeal Rights were discussed and provided.

NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Tanya Washington
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 07/28/2026 01:13 PM - It Cannot Be Edited


Created By: Tanya Washington On 07/27/2026 at 02:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SAFI, KARISHMA
FACILITY NUMBER: 343624357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed two large kitchen knifes in the lower kitchen cabinet. Licensee's sister threw one knife on top of the upper kitchen cabinet to make it inaccessible and when LPA informed her that wasn't safe practice she placed the other knife in the upper kitchen cabinet.
POC Due Date: 07/28/2026
Plan of Correction
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Licensee must submit a written plan explaining that she and all adults in the home will ensure that all sharp objects are safely stored and inaccessible to children.
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Upon arrival to the facility LPA observed an infant asleep in a playpen with two loose blankets, baby bottle and two plastic gloves near infants head.
POC Due Date: 07/28/2026
Plan of Correction
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When Licensee arrived she explained that she recently took the training however when she was away her sister wasn't aware of these safety practices and placed the infant to sleep in the play pen with blankets, plastic gloves and a baby bottle. Licensee needs to submit a written plan of correction to address the violation.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Amanda Blesi
NAME OF LICENSING PROGRAM MANAGER:
Tanya Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 07/28/2026 01:13 PM - It Cannot Be Edited


Created By: Tanya Washington On 07/27/2026 at 02:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SAFI, KARISHMA
FACILITY NUMBER: 343624357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Upon arrival to the facility LPA observed Tamana Safi providing care and supervision to two children. The Licensee was at an appoitment when LPA arrived. This is a Zero Tollerance violation and a civil penalty in the amount of $500.00 is assessed for having an unfingeprinted adult supervising daycare children.
POC Due Date: 07/27/2026
Plan of Correction
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The LPA provided a blank LIC9163 LIVESCAN form and advised Licensee that Tamana needs to be fingerprinted by POC 07/27/2026.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Amanda Blesi
NAME OF LICENSING PROGRAM MANAGER:
Tanya Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
Page: 6 of 10
Document Has Been Signed on 07/28/2026 01:13 PM - It Cannot Be Edited


Created By: Tanya Washington On 07/27/2026 at 02:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SAFI, KARISHMA
FACILITY NUMBER: 343624357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed that the last fire drill was documented 11/22/2024.
POC Due Date: 08/27/2026
Plan of Correction
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Licensee is required to conduct a fire safety drill with the children and document by August 27, 2026.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2026
Plan of Correction
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The Licensee stated that she recently particiapted in Technical Support Program and learned about documenting Safe Sleep practices, however her sister who was left alone with children did not know the regulations. The Licensee did not provide any previous documentation of safe sleep logs for Child #1 who was in care at the time of inspection.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Amanda Blesi
NAME OF LICENSING PROGRAM MANAGER:
Tanya Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
Page: 7 of 10
Document Has Been Signed on 07/28/2026 01:13 PM - It Cannot Be Edited


Created By: Tanya Washington On 07/27/2026 at 02:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SAFI, KARISHMA
FACILITY NUMBER: 343624357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed that the Licensee's CPR and First Aid certificate expired 10/2025 and her sister who was present alone does not have certification.
POC Due Date: 08/27/2026
Plan of Correction
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The Licensee will ensure to renew her CPR and First Aid Training by POC date of 08/27/2026. Licensee was made aware that if her sister is ever left alone with children she needs to have her own certifcation.
Type B
Section Cited
CCR
102416.2(a)(2)
Reporting Requirements
(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee did not submit an application update LIC279 notifying the department that her parents moved out.
POC Due Date: 07/31/2026
Plan of Correction
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Licensee was provided blank LIC279 form and asked to update the form listing current residents.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Amanda Blesi
NAME OF LICENSING PROGRAM MANAGER:
Tanya Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
Page: 8 of 10
Document Has Been Signed on 07/28/2026 01:13 PM - It Cannot Be Edited


Created By: Tanya Washington On 07/27/2026 at 02:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SAFI, KARISHMA
FACILITY NUMBER: 343624357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Licensee's sister Tamana did not have required vaccines on file as required for an assistant.
POC Due Date: 08/27/2026
Plan of Correction
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2
3
4
Licensee stated that her sister will no longer help watching children and that she was only here covering for her due to emergency appointment. Licensee needs to submit a written plan explaining how she will correct this violation.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The Licensee did not have files for two children who were here today. The only document the LIcensee presented was Immunzation record from the hospital which showed children's names and date of birth.
POC Due Date: 08/27/2026
Plan of Correction
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2
3
4
Licensee will ensure to create files for the children with all required documents. LPA will return to verify after 08/27/2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Amanda Blesi
NAME OF LICENSING PROGRAM MANAGER:
Tanya Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
Page: 9 of 10
Document Has Been Signed on 07/28/2026 01:13 PM - It Cannot Be Edited


Created By: Tanya Washington On 07/27/2026 at 02:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SAFI, KARISHMA
FACILITY NUMBER: 343624357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The Licensee has a children's roster, however it was not up to date and not all children who currently attend were listed on it.
POC Due Date: 08/27/2026
Plan of Correction
1
2
3
4
LPA will return to verify that the children's roster was updated.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Amanda Blesi
NAME OF LICENSING PROGRAM MANAGER:
Tanya Washington
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2026


LIC809 (FAS) - (06/04)
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