343625580-4-2-2024-03-CC-MGAO-D3XNRL-20240402104143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625580
Report Date: 04/02/2024
Date Signed: 04/02/2024 10:41:53 AM

Document Has Been Signed on 04/02/2024 10:41 AM - 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, FARIDA		FACILITY NUMBER:	343625580
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	04/02/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Farida Safi		TIME COMPLETED:	10:50 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	At 9:00 a.m. on 4/2/2024, Licensing Program Analyst (LPA) Matthew Gallo met with applicant Farida Safi for the purpose of a change of location prelicensing inspection. Applicant's husband was present for the inspection and provided interpretative services. Applicant has requested a Small Family Childcare Home License to serve up to 8 children, and was previously licensed at facility # 343624861. Today's census included 0 day care children. The facility is a two story, 4 bedroom 3 bathroom home. The downstairs consists of Living room 1, Living Room 2, Dining Room, Kitchen, Bathroom, and Garage. The upstairs consists of Bedrooms 1-4 and 2 bathrooms. A backyard is fenced. Off limit areas include: all upstairs and garage. Applicant understands that children must never enter these areas. Applicant understands that any unfenced areas of the property require 100% supervision. Applicant intends to operate 6:00am-12:00am, Monday-Sunday, year-round. Applicant understands they must be present at the facility for 80% of operating hours per day. Applicant understands that their own family members under 10 years old count toward the ratio. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant was reminded that all adults 18 and over living or working in the home, 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. Report continues on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

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: SAFI, FARIDA	FACILITY NUMBER: 343625580
	VISIT DATE: 04/02/2024

NARRATIVE

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LPA and applicant toured the entire facility and property. All toxic and hazardous items are inaccessible to children and applicant understands that any cabinet containing such items and is reachable by children must be made inaccessible. LPA observed a 2A10BC fire extinguisher along with functioning smoke and carbon monoxide detectors. Applicant stated that there are no firearms in the facility, and LPA observed no bodies of water on the property. Stairway is fenced and fireplace in Living Room 2 is barricaded to prevent access by children.

Applicant provided proof of control of property in the form of ownership. Applicant understands that until a liability insurance coverage in the amount of $300,000 is provided, the affidavit form LIC282 form will be used.

Applicant’s EMSA certified CPR and First Aid Certificate expires January 14, 2025. Mandated Reporter Training is not offered in the applicant’s first language, therefore she is exempt. Applicant understands the CPR/First Aid training must be renewed every two years.

LPA reviewed Safe Sleep regulations and provided the 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, an updated Plan of Operation that includes 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Report continues on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

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: SAFI, FARIDA	FACILITY NUMBER: 343625580
	VISIT DATE: 04/02/2024

NARRATIVE

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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 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.

Licensee was informed of the MyChildCarePlan.org website; 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.

This facility evaluation report was reviewed and discussed with the applicant, Farida Safi. LPA discussed supervision, personal rights, criminal record clearances, ratios and capacity, required postings, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining to family childcare homes.

Effective today, 4/2/2024, the facility is issued a small license for a maximum of 6 children with no more than three infants or four infants only, or 8 children with no more than two infants and one child at least age 6 and one child enrolled and attending pre-kindergarten or elementary school.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

LIC809 (FAS) - (06/04)

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