343625032-6-9-2023-03-CC-MGON-CSMT36-20230609142148

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625032
Report Date: 06/09/2023
Date Signed: 06/09/2023 02:22:00 PM

Document Has Been Signed on 06/09/2023 02:22 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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	KOLMANI, KAMILA		FACILITY NUMBER:	343625032
ADMINISTRATOR:	KOLMANI, KAMILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 263-5744
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95864
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	06/09/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kamila Kolmani		TIME COMPLETED:	02:45 PM

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On Friday June 9th, 2023 Licensing Program Analyst (LPA) Mandie Goodwin met with Applicant Kamila Kolmani for the purpose of conducting an announced change of location pre-licensing inspection. Applicant was previously licensed under facility #343624525. During today’s inspection applicant’s spouse was present and provided translation. All individuals subject to criminal background review have cleared background checks. Applicant plans to operate Monday through Friday 12:00pm-9:00pm.

A health and safety inspection was conducted inside and outside the home. Applicant leases a single story home which includes an entry hall, 2 bathrooms, kitchen, second hall, and 3 bedrooms. The home has a fully fenced backyard. The off limits areas include room 2 and room 3 and bathroom #2. The kitchen and entry hall #2 are off limits except to walk through to go outdoors. Applicant understands that children may never access these off limit areas except as specified.

Toxic and hazardous items are inaccessible to children and out of children’s reach. LPA advised the applicant that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. A functioning combination smoke detector and carbon monoxide detector was observed, and a 2A10BC fire extinguisher was observed. Applicant stated that there are no weapons in the home.

Applicant has completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training. Current EMSA approved pediatric CPR/First Aid trainings were verified and expires 5/14/24. Applicant is exempt from mandated reporter training as it is not offered in her first language at this time.

Applicant was encouraged to maintain supervision at all times. Applicant understands that if an unusual incident occurs, licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. LPA discussed Type A/B citations, open door policy, fire drills, smoking prohibition, and children’s personal rights with the applicant. Continued on 809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KOLMANI, KAMILA	FACILITY NUMBER: 343625032
	VISIT DATE: 06/09/2023

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A current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer in care. Applicant’s own children under the age of 10 count towards total capacity.

Applicant understands that if they want to make any off-limit area an on-limits area, licensing must be notified and LPA must do an inspection before children are allowed in the area. Applicant understand that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. If applicant chooses to not operate the childcare anymore, licensing must be notified in writing. LPA reviewed with applicants the LIC 311D (Forms/Records To Keep In Your Family Child Care Homes), children’s forms/records, facility forms/records, and information to be posted.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with 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.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KOLMANI, KAMILA	FACILITY NUMBER: 343625032
	VISIT DATE: 06/09/2023

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Applicant understands that there shall be one crib or play yard for each infant in care who is unable to climb out of a crib or play yard and an infant sleep plan form LIC9227 shall be kept on file for all infants under 12 months. Applicant understands that infants shall not be swaddled in care, and cribs or play yards shall be free of all loose articles and objects. Applicant understands that they shall physically check on a sleeping infants under 24 months every 15 minutes and document.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with Kamila Kolmani..

As of 6/9/2023 facility is approval 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 3 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2. Landlord consent for 7^th and 8^th child.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

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