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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625942
Report Date: 10/29/2024
Date Signed: 10/29/2024 02:31:20 PM

Document Has Been Signed on 10/29/2024 02:31 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:AHMADZAI, KHATIMAFACILITY NUMBER:
343625942
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
10/29/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Khatima AhmadzaiTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On Tuesday, October 29, 2024, Licensing Program Analyst (LPA) Amanda Sutter met with licensee Khatima Ahmadzai for the purpose of a Capacity Increase from 6 to 12 children. The Fire Safety Inspection Clearance has been received from the Sacramento Metro Fire Department on October 17, 2024, and the home has been cleared for up to 14 children. All individuals subject to criminal background review have obtained a criminal record clearance. Upon arrival, LPA observed licensee supervising two children. The licensee's husband and the children's mother was also present.

The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once approved, they can operate with a maximum capacity of 12 children. 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 (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 14 children.

A health and safety evaluation was conducted in all areas accessible to children. Off-limit areas include: backyard, garage, and bedrooms 1 and 3 at the end of the hall. Licensees acknowledged that children may never enter these off-limit areas. LPA observed a fire drill log. The last fire drill was conducted 10/1/24.

Large family child care home capacity limitations were reviewed during today's visit. Licensees acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensees acknowledges that children residing in the home under the age of 10 years shall be included in capacity.

A notice of site visit was given and must remain posted for 30 days. No citations have been issued. Exit interview conducted and report was reviewed with the licensee Khatima Ahmadzai.

Effective today, October 29, 2024, LPA will approve the capacity increase to serve up to 12 children, four (4) of which may be infants. Infants are children under the age of 2.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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