343625263-10-10-2023-03-CC-EPGO-CWGVHL-20231010162718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625263
Report Date: 10/10/2023
Date Signed: 10/10/2023 04:27:38 PM

Document Has Been Signed on 10/10/2023 04:27 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:	SAFI, ATIFA		FACILITY NUMBER:	343625263
ADMINISTRATOR:	SAFI, ATIFA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 346-5966
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	10/10/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Atifa Safi		TIME COMPLETED:	10:40 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	This is a Change of Location from previous facility number 343623949 Licensing Program Analyst (LPA) Erwina Pascual-Golamco conducted a Change of Location inspection and met with Applicant Atifa Safi and assistant Hikmatullah Karimi. Census included 1 child of their own, there were no other adults in the home during the inspection. Fire clearance was granted on 09/19/23. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday through Friday from 7:00 AM to 9:00 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 5 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. continued on LIC809C...

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

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: SAFI, ATIFA	FACILITY NUMBER: 343625263
	VISIT DATE: 10/10/2023

NARRATIVE

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Incidental Medical Services (IMS) was discussed with Applicant. 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

A health and safety inspection were conducted inside and out. This facility is a two story home. The first floor has a main hall, living room, one bedroom, one bathroom, hall closet, kitchen, garage, laundry room and an office room. The second floor has 3 bedrooms and 2 bathrooms. The off-limit areas will be: the entire second floor, hall closet, kitchen, laundry room, garage, office room, shed, left and right side of yard. Off-limit areas will remain inaccessible to children by closed doors and/or supervision. LPA observed a safety gate which is barricading the upstairs area. Applicant understands that whenever children under the age of five are present the safety gate must be up, preventing access to the second floor. Toxic and hazardous items are inaccessible to children and are stored in the garage and locked shed in the yard. Functioning smoke and carbon monoxide detectors and fire extinguisher were observed in the home. LPA received Mandated Reporter Training and is valid until 04/25 and Pediatric CPR and First Aid training is valid until 07/25 from last annual visit 07/20/23. Applicant understands both CPR and MRT must be renewed every two years. Applicant stated she understands that her own children under the age of 10 count as part of the ratio. Applicant stated that there are no weapons in the home. LPA observed a fireplace in the family room area which is barricaded. Backyard is fenced, LPA observed a trampoline that is barricaded on the right side of the yard, and applicant stated it is off limits. Supervision was discussed and applicant understands that children must be 100% supervised in unfenced yards. Immediate Civil Penalty regulation and deficiencies were reviewed.

continued on LIC809C...

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: SAFI, ATIFA	FACILITY NUMBER: 343625263
	VISIT DATE: 10/10/2023

NARRATIVE

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LPA consulted applicant regarding the following topics; new upcoming regulations, Type A vs. Type B deficiencies, complaints, LPA’s right to interview children without parental consent, civil penalties, incidental medical services, placement of detergents, placement of poisons, placement of medicines, announced vs. unannounced inspections, posting requirements, unusual incident reports, On-limits vs. Off-limit areas, licensing file management, fire drills, 80% supervision, 100% supervision, fingerprint clearances, advertising, mandated reporting and best practices.

LPA consulted the applicant regarding personal rights. Applicant understands that corporal, physical and/or unusual forms of punishment is never allowed toward day care children or their own children during day care hours. LPA provided the Community Care Licensing website www.ccld.ca.gov, so the Applicant can obtain updated licensing information, new regulations, and access forms. LPA advised Applicant of their responsibility to stay current regarding new regulations.

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.

LPA reviewed with applicant the LIC311D, Forms/Records to Keep in Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

continued on LIC809C...

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

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: SAFI, ATIFA	FACILITY NUMBER: 343625263
	VISIT DATE: 10/10/2023

NARRATIVE

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Applicant was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, self-assessment guides, regulations and legislation pertaining to family childcare homes. 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 license 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.

On this date, 09/07/2023, 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 address. 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.

The following items are required before a license will be issued:

- Fitted sheet for the play yard
- Licensing Program Manager's final file review

At the time that LPA receives documentation that the above items are completed, this large family childcare home will be licensed.

Exit interview conducted with Applicant and assistant, Atifa Safi and Hikmatullah Karimi.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC809 (FAS) - (06/04)

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