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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624728
Report Date: 12/21/2022
Date Signed: 12/21/2022 12:30:25 PM

Document Has Been Signed on 12/21/2022 12:30 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:AMIN,BIBI KAUSARFACILITY NUMBER:
343624728
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Bibi Kausar AminTIME COMPLETED:
12:45 PM
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At 11:45 a.m. on Thursday, December 21st, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Applicant, Bibi Kausar Amin, for the purpose of an announced, prelicensing inspection for a change of location. Applicant was previously licensed at facility number 343623816. Applicant understands that the old facility number will be closed as of this date and they are longer able to operate in previous location. Licensee’s spouse was also present during today’s inspection and provided translation assistance. Hours of operation are 8:00 a.m. - 9:00 p.m., Monday thru Friday.

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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Applicant guided LPA on a tour of the facility. The two story home consists of 4 bedrooms, 3 bathrooms, kitchen, living room, laundry room and garage. There is also a separate detached unit on the premises. Off-limit areas consist of master bedroom and laundry room. Applicant acknowledges that child care children must never enter the off-limits area. LPA observed functioning smoke and carbon monoxide detectors, and a 2A10-BC fire extinguisher. LPA reviewed the required postings. Cleaning materials, hazardous items, and medications are all stored inaccessible to children. There are no bodies of water on the premises. Applicant stated that there are no firearms nor poisons in the home. LPA observed gates for the stairs.

report continued on 809-C.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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: AMIN,BIBI KAUSAR
FACILITY NUMBER: 343624728
VISIT DATE: 12/21/2022
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Applicant owns the home and provided proof of control of property. Applicant has completed the required Preventative Health and Safety course. Applicant and spouse's current in person EMSA approved CPR and First Aid certification was verified and expires on 12/10/2024.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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 observed a crib in the home. LPA reminded applicant that cribs shall be free of loose articles and objects, and mattresses shall be covered with a tightly fitted sheet.

As of today 12/21/2022, facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
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