343625419-2-13-2024-03-CC-DVAG-D2EUSH-20240213145023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625419
Report Date: 02/13/2024
Date Signed: 02/13/2024 02:50:31 PM

Document Has Been Signed on 02/13/2024 02:50 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:	KOHISTANI, ILHAMUDIN		FACILITY NUMBER:	343625419
ADMINISTRATOR:	KOHISTANI, LLHAMDUIN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 710-4762
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95815
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	02/13/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kohistani, Ilhamudin		TIME COMPLETED:	03:30 PM

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At 1:00 p.m. on Tuesday, February 13, 2024, Licensing Program Analyst (LPA) Pa Dao Vang met with Applicant, Ilhamudin Kohistani, for the purpose of an announced, pre-licensing inspection. Applicant's younger sister and mother was home during the inspection. Applicant also speaks Dari and Pashto languages. Facility hours of operation are from 8:00 a.m.- 9:00 p.m., Monday thru Friday.

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee 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.

APPLICANT RENTS THE HOME AND DOES NOT HAVE LANDLORD CONSENT: The applicant did not obtain a signed Property Owner/Landlord Consent form (LIC9149). Without this consent the applicant understands that, once licensed, they can operate with a maximum capacity of 6. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8.

APPLICANT LEASES THE HOME: The applicant provided proof of control of property.

Continue report on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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: KOHISTANI, ILHAMUDIN	FACILITY NUMBER: 343625419
	VISIT DATE: 02/13/2024

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The one story apartment consists of 3 bedrooms, 2 bathrooms, living/dining room, backyard, garage, and kitchen. Off limits area includes bedroom #1, living/dining room, backyard, garage and kitchen. Applicant understands that their own children under 10 years old will count toward the childcare ratio when present during childcare hours. LPA observed functioning smoke and carbon monoxide detectors. LPA did observed a working fire extinguisher 2A-10-BC.

There are no bodies of water. Applicant understands 100% supervision shall be maintained in or around bodies of water, and in unfenced areas. Applicant stated that there are no weapons nor poisons in the home. Cleaning compounds, knives and medications are placed on high shelves, inaccessible to children.

Applicant has completed the required Preventative Health and Safety course which includes 1 hour of nutrition and lead prevention training. CPR and First aid certification were verified and will expire 1/7/2026. Applicant is exempt from Mandated Reporter Training due to language barriers. Applicant understands that CPR/First Aid certification must be renewed every 2 years. LPA provided blank forms required for children's records including immunization card and emergency identification. LPA also provided the Parent's Rights form/poster, and reviewed vaccination requirements for children.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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. LPA observed a crib free of loose objects in the facility. LPA discussed about the infant sleep log required for each child under the ages of 1years old. Licensee must check and documenting each infant sleeping every 15 minutes. LPA provided an example of the infant sleep log to applicant.

Continue report on LIC809-C…

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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: KOHISTANI, ILHAMUDIN	FACILITY NUMBER: 343625419
	VISIT DATE: 02/13/2024

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Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if they relocate and wants to continue to provide care, they must submit a change of location application and have the new home inspected.

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 624B shall be submitted within seven days to remain in compliance.

Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months. Smoking prohibition and regional office relocation were discussed.

Applicant understands to pay the annual fees of $73.00 before the due date. The annual bill will be sent through the mail with facility number, pin, and the amount of it. Applicant can pay it through the department website at https://cdss.ca.gov/inforesources/community-care/licensing-fees . They may also pay in person in our office or mailing with check/Money Order/personal check to the address listed below:

CA Department of Social Services
MS 9-3-67
P.O. Box 944243
Sacramento, CA 94244-2430

On this date, 2/13/2024, 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.

Continue report on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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: KOHISTANI, ILHAMUDIN	FACILITY NUMBER: 343625419
	VISIT DATE: 02/13/2024

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This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining to family childcare homes.

Effective today, Tuesday, February 13, 2024, facility is approved for a Small Family Child Care Home license for a capacity of 6 children with 4 infants only or no more than 3 infants with 2 preschoolers and 1 child in Transitional Kindergarten or above.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Dao Vang
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC809 (FAS) - (06/04)

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