343624958-5-4-2023-03-CC-MGAO-CRHMW5-20230504095746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624958
Report Date: 05/04/2023
Date Signed: 05/04/2023 09:58:07 AM

Document Has Been Signed on 05/04/2023 09:58 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	NOORISTANI, TAMANA & FATIMA		FACILITY NUMBER:	343624958
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	05/04/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tamana Nooristani		TIME COMPLETED:	10:10 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 9:00 a.m. on May 4th, 2023, Licensing Program Analyst (LPA) Matthew Gallo met with Applicant, Tamana Nooristani, for the purpose of an announced prelicensing change of location inspection. Applicant was previously licensed at facility 343624362. Applicant understands that effective today, the old facility will be closed and care can no longer take place at that location. Applicant's assistant was present during today's inspection. Facility operating hours will be from 7:30 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 home is the bottom unit of a duplex and consists of 3 bedrooms, 2 bathrooms, living room, kitchen, and laundry room. Off-limit areas include laundry room and master bedroom/bath. Applicant acknowledges that child care children must not enter these off limits areas of the home, and their own children under 10 years will count toward the childcare ratio when present during operating hours. LPA observed a 2A10-BC fire extinguisher and functioning combination smoke and carbon monoxide detectors. 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 weapons nor poisons in the home. Report continued on LIC809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: NOORISTANI, TAMANA & FATIMA	FACILITY NUMBER: 343624958
	VISIT DATE: 05/04/2023

NARRATIVE

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Applicant rents the home and has provided a lease showing proof of control of property. Applicant has completed the required Preventative Health and Safety course which includes 1 hour of nutrition and lead prevention training. CPR and First aid certification was verified and will expire 11/23. Applicant understands that CPR/First aid certification must be renewed every 2 years. Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months.

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.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Applicant understands that if any changes are made to the off limits of the home; licensing must be notified and a safety inspection conducted prior to any child care children being able to have access to the area. Smoking prohibition was discussed.

This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. Applicant was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Effective today, Wednesday, May 4th, 2023, 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: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC809 (FAS) - (06/04)

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