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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625144
Report Date: 08/25/2023
Date Signed: 08/25/2023 03:47:28 PM

Document Has Been Signed on 08/25/2023 03:47 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:HASHIMI, BIBI MAWLODAFACILITY NUMBER:
343625144
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/25/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Hashimi, Bibi MawlodaTIME COMPLETED:
04:00 PM
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On Friday August 25, 2023, at approximately 2:40 PM, Licensing Program Analyst (LPA) Josiah Gathing met with Applicant Bibi Mawloda Hashimi, for the purpose of an announced pre-licensing inspection. Applicant plans to operate every day 6:00 AM to 8:00 PM. Applicant’s spouse and two children were also present during today’s inspection. Applicant’s first language is Dari and LPA applicant’s child provided interpretation. All persons subject to criminal record background review have been cleared.

A health and safety inspection was conducted inside and outside the home. The single-story home has two bedrooms, one bathroom, a living room, kitchen, and back yard with shed. Off-limits areas: Shed.



LPA observed a functioning smoke detector, carbon monoxide detector, 2A10BC fire extinguisher, and first aid kit in the home. Per applicant, there are no weapons in the home and poisons are locked.

Applicant completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training on March 9, 2023. Applicant’s EMSA certified CPR and First Aid Certificate expires December 10, 2024. Mandated Reporter Training is not offered in the applicant’s first language, therefore she is exempt.

Applicant was encouraged to maintain supervision at all times in unfenced areas. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed.

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 continues on LIC809-C…

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2023
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: HASHIMI, BIBI MAWLODA
FACILITY NUMBER: 343625144
VISIT DATE: 08/25/2023
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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 submitting 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 Applicant 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 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.

An exit interview was conducted with Applicant and Covid-19 protocols were discussed. LIC311D, records, postings, and reporting requirements were discussed. LPA discussed personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

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.

As of today August 25, 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, with 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: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC809 (FAS) - (06/04)
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