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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626358
Report Date: 12/04/2024
Date Signed: 12/04/2024 02:28:58 PM

Document Has Been Signed on 12/04/2024 02:28 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:NOORI, ATIAFACILITY NUMBER:
343626358
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Atia NooriTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On Wednesday, 12/4/2024, Licensing Program Analysts (LPA) Amanda Sutter met with Applicant Atia Noori for the purpose of an change of location pre-licensing inspection. Applicant was previously licensed under facility #343625256. During today’s visit, applicant’s husband was also present in the home. Applicant speaks Nooristani and Pashto. Applicant’s husband assisted with translation. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday through Friday from 7:30 AM to 8:00 PM.

A health and safety inspection was conducted inside and outside the home. The facility is a one-story home which includes 3 bedrooms, 2 bathrooms, kitchen, a living room, a garage, and a backyard. A shed and a detached garage are also in the backyard. Off-limit areas will include: master bedroom, garage, and backyard. Applicant understands that children may never enter these off-limit areas.

Toxic and hazardous items are inaccessible to children and out of children’s reach. Sharp knives are stored on a high shelf out of children’s reach. Children’s medication will be stored in a closet in the master bedroom. A functioning smoke detector and 2A10BC fire extinguisher were observed. Applicant stated that there are no weapons or poisons in the home. LPA advised the applicant that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. LPA discussed all required licensing postings. LPA observed an unfenced pond in the backyard. LPA discussed fencing and covering requirements with Applicant per AB2866 guidelines.

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Current EMSA approved pediatric CPR/First Aid trainings were verified and expire 6/2025. Applicant understands this training must be renewed every two years. Mandated Reporter Training is not offered in the Applicant’s primary language, therefore she is exempt from the requirement to take the training.
PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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: NOORI, ATIA
FACILITY NUMBER: 343626358
VISIT DATE: 12/04/2024
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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.

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.

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.

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. Applicant was informed of the MyChildCarePlan.org site, 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.

Exit interview conducted and report was reviewed with the applicant Atia Noori.

Facility is pending until proof of the following is submitted:
- Proof of purchase of a Carbon Monoxide detector
- Proof of secured pond in backyard
- Updated sketch of yard to include pond, outdoor shed, and outdoor garage.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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