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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625126
Report Date: 09/06/2023
Date Signed: 09/06/2023 02:24:18 PM

Document Has Been Signed on 09/06/2023 02:24 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:SALARZAI, ZAINABFACILITY NUMBER:
343625126
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
09/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Zainab SalarzaiTIME COMPLETED:
02:35 PM
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Licensing Program Analyst Jennifer Velasco (LPA) met with Applicant Zainab Salarzai (Applicant) to conduct an announced Pre-Licensing inspection. LPA toured Applicant's home. All adults currently living or working in the home have received a criminal background clearance and are associated to the facility. Applicant provided proof of control of property. Applicant stated the facility hours will be Monday - Sunday, 6:00 AM – 10:00 PM.

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, 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 five 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.

The California Attorney General - Megan's Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Off-limit areas will consist of: Left and right side yards kitchen, pantry, utility closets, garage, stairs to second story, entire second story, and outdoor storage area. The backyard is not yet landscaped and is therefore currently off limits but will be on limits later possibly. APPLICANT understands that children may never enter the off-limit areas. APPLICANT acknowledges she is required to notify Licensing prior to making changes to off-limit areas so that they may be inspected for safety. LPA observed a functioning smoke and carbon monoxide detector and 2A-10-BC fire extinguisher. Hazardous cleaning products and chemicals, knives, and medications are all stored inaccessible to children.

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SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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: SALARZAI, ZAINAB
FACILITY NUMBER: 343625126
VISIT DATE: 09/06/2023
NARRATIVE
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APPLICANT understands that poisons must be locked. The backyard is fenced. LPA advised APPLICANT in areas that are not fenced, 100% supervision must be maintained at all times. APPLICANT stated she does not have any firearms and LPA did not observe any bodies of water on the property. There is a creek near the externa back edge of the property, which has a regulation compliant five foot wrought iron fence.

LPA reviewed with Applicant the LIC 311 D, Forms/Records to Keep In Your Family Child Care Homes, children's forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. APPLICANT has a current pediatric CPR/1st aide certificate and has completed the preventative health and safety course. APPLICANT has completed the Mandated Reporter training and has provided proof of immunizations.

APPLICANT was reminded that the CPR/First Aid and Mandated Reporter certificates must be updated every two years. LPA obtained proof that the APPLICANT lives in the home. APPLICANT understands that if she does not have liability insurance, she will have parents fill out an affidavit.

LPA reviewed current COVID-19 guidelines, postings, and protocols.

LPA reviewed Type A and Type B citations, Zero Tolerance, and Civil Penalties. LPA reviewed open door policy, supervision, fire drills, children’s personal rights, reporting requirements, and the smoking prohibition with the APPLICANT. A current roster of children enrolled must be available and maintained for a period of three years after children are no longer in care. LPA went over requirements for an assistant.

LPA reminded APPLICANT that annual fees must be paid promptly and by the due date or late fees will be assessed. LPA advised APPLICANT that she has the option to put her home on Inactive Status at any time for up to a year while continuing to pay fees.

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SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SALARZAI, ZAINAB
FACILITY NUMBER: 343625126
VISIT DATE: 09/06/2023
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LPA discussed with APPLICANT safe sleep regulations and the Child Care Licensing Safe Sleep webpagehttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed APPLICANT 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 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) or (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.

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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Applicant was informed of the MyChildCarePlan.org site, 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.

As of today's date, 09/06/2023, APPLICANT is now licensed as a Small Family Child Care Home with 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. Exit interview conducted and report reviewed with the APPLICANT.


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SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
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