343625109-7-13-2023-03-CC-TWAN-CTPN9U-20230713101632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625109
Report Date: 07/13/2023
Date Signed: 07/13/2023 01:15:35 PM

Document Has Been Signed on 07/13/2023 01:15 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:	ANDAR, HAJERA		FACILITY NUMBER:	343625109
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 2	DATE:	07/13/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Hajera Andar		TIME COMPLETED:	10:30 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	On July 13, 2023 at 8:30 AM, Licensing Program Analyst (LPA) Tanya Washington met with Applicant Hajera Andar for the purposes of a scheduled pre-licensing/ change of location inspection. Applicant's daughter Trina Andar interpreted from English to Dari. Applicant was previously licensed at #343624521. All adults residing in the home have obtained required fingerprint clearances and the clearances have been transferred. The hours of operation will be Monday-Sunday from 7:00 AM to 10 PM. LPA and Applicant toured the entire home inside and out. Applicant rents the home and a copy of the rental agreement was provided to show control of property. Applicant obtained permission from the landlord to provide care up to eight children and signed form LIC9149 is on file. This facility is located on the premises of Sierra Park Townhomes complex. The facility has two floors, the first floor has a living room, kitchen, dining area, laundry, bathroom and a fenced outdoor patio. The second floor has three bedrooms and a bathroom. The off limit area will include: the laundry room and the entire second floor. Applicant understands that children may not have access to the off limit areas. LPA observed a gate at the bottom of the stairs and applicant understands that whenever children under the age of 5 are present the gate must be installed. Applicant was notified that she would need to contact the department before making any on-limits areas to off-limits or vice versa. All of the toxic or dangerous materials are inaccessible. The facility has a working telephone, fully charged fire extinguisher, first aid supplies, smoke detector, and carbon monoxide detector that meets regulations. As per the applicant, there are no firearms or weapons in the facility. All sharp objects and cleaning solutions are stored out of children's reach. There is no fireplace in the home. There is a in-ground pool in the complex that is fenced according to Title 22 regulations. Applicant 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. Report continued on LIC809-C

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ANDAR, HAJERA	FACILITY NUMBER: 343625109
	VISIT DATE: 07/13/2023

NARRATIVE

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LPA discussed the licensing regulations, safe sleep procedures, and provided applicant with information on how to access PINs online at the CCLD website. Applicant has submitted record of all the required immunization, CPR valid. Applicant understands that fire/earthquake drills are to be conducted every 6 months and recorded. The applicant understands that baby walkers and smoking are prohibited within the facility.

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.

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 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

Applicant is exempt from Mandated Reporter training due to language barrier.

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

Effective today, 07/13/2023, the facility is licensed for a maximum of 6 children - no more than three infants or four infants only. 8 children no more than two infants and one child at least age 6 and one child enrolled and attending pre-kindergarten or elementary school.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC809 (FAS) - (06/04)

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