343625515-3-20-2024-03-CC-JMCN-D3JSMR-20240320140023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625515
Report Date: 03/20/2024
Date Signed: 03/20/2024 02:00:31 PM

Document Has Been Signed on 03/20/2024 02:00 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:	YUSOFZAI, NOORYAA		FACILITY NUMBER:	343625515
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	03/20/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Nooryaa Yusofzai		TIME COMPLETED:	02:15 PM

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	Licensing Program Analyst (LPA) Jeremey McClain conducted a Pre-Licensing inspection with applicant Nooryaa Yusofzai. Licensee’s adult son provided translation during the inspection. Applicant is applying for a Small Family Child Care License. A health and safety inspection of the home was conducted. Applicant resides in a two-story home consisting of five bedroom, three bathrooms, a living room, a dining area, a kitchen, a garage, and a fenced backyard. The off-limits areas in the home will be the upstairs, the laundry room, and the garage. Off-limits areas will remain inaccessible to children by closed doors and or supervision. Applicant plans to operate Monday through Saturday from 6 am to 5 pm. The home appeared clean and orderly, and toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors and a 2A10BC fire extinguisher were observed in the home. Current pediatric CPR and first aid training was verified. Applicant stated there are no weapons in the home. No bodies of water were observed at the home. Applicant has provided proof of Immunization for Pertussis, Measles and Influenza. Tuberculosis clearances for all adults in the home have been provided. All individuals subject to criminal background review have obtained a criminal record clearance. 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, 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.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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: YUSOFZAI, NOORYAA	FACILITY NUMBER: 343625515
	VISIT DATE: 03/20/2024

NARRATIVE

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On this date, 01/09/2024, 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.

Applicant understands that any adult assistants for the childcare must also obtain the following: EMSA certified CPR and first aid training, immunizations for measles Pertussis and Influenza, complete AB1207Mandated Reporter Training, and complete eight hours of preventative health and safety training.

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. Applicant was encouraged to always maintain supervision. LPA advised applicant that 100% supervision is required in areas outside of the home that are unfenced.

LPA explained to applicant that if they move and want to continue to provide care, they must submit a change of location application and have the new home inspected.

LPA discussed Unusual Incidents and reporting requirements. 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 624 shall be submitted within seven days to remain in compliance.

Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Applicant understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area.

LPA reviewed with applicant the LIC 311D, 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 understands that children’s records are to be maintained and be accessible to licensing for up to three years after the child is no longer enrolled. LPA discussed the necessity for applicant to obtain and record children’s immunizations on form PM 286. Applicant understands that if they do not attain a $300,000 liability insurance policy, form LIC 282 must be provided to parents.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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: YUSOFZAI, NOORYAA	FACILITY NUMBER: 343625515
	VISIT DATE: 03/20/2024

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LPA discussed capacity and ratios with applicant. Applicant understands that their own children under the age of 10 will count towards the ratio when present.
LPA informed applicant that all inspections after today will be unannounced. Immediate Civil Penalties were discussed. LPA informed applicant of smoking prohibition.
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.
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.

The applicant provided proof of control of property.

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-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Nooryaa Yusofzai..

Effective today, 03/20/2024, applicant 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: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC809 (FAS) - (06/04)

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