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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626667
Report Date: 04/23/2025
Date Signed: 04/23/2025 02:11:23 PM

Document Has Been Signed on 04/23/2025 02:11 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:SAMIMI, AREFAFACILITY NUMBER:
343626667
ADMINISTRATOR/
DIRECTOR:		SAMIMI, AREFAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 516-9274
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/23/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Arefa SamimiTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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This is a Change of Location from previous facility number 343625361 and Capacity Increase.
On April 23, 2025, Licensing Program Analyst (LPA) Julia Maryanova met with Licensee, Arefa Samimi. Licensee has requested to increase from a small family childcare to a large family childcare. Hours of operation will be Monday through Friday from 8:00 AM to 9:00 PM.

A health and safety inspection was conducted on the interior and exterior of the home. A fire clearance was granted on 04/14/2025. The home is a one story half-plex which includes two bedrooms, one bathroom, kitchen, living room, sun room, den, laundry room, one car garage and backyard. Off-limit area includes the bedroom on the right, laundry room and garage. Licensee acknowledges childcare children may never enter off-limit areas. The facility has toys and equipment safe for children. LPA observed a functioning smoke detector, carbon monoxide detector, and 2A10BC fire extinguisher within the home. LPA observed the backyard is fenced, and Licensee acknowledges in areas that are not fenced 100% supervision is required. Toxic and hazardous items, sharp knives, and medications are inaccessible to children. LPA advised the Licensee that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. Licensee stated there are no weapons on the premises. There are no bodies of water at the facility. Licensee acknowledges 100% supervision is required around bodies of water.

Licensee has completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training. Current EMSA approved pediatric CPR/First Aid training was completed and expires April 18, 2027. Licensee understands CPR/First Aid Training must be completed every two years. Licensee is exempt from taking the Mandated Reporter Training due to it not being available in her primary language.

LPA discussed capacity and supervision with applicant. Licensee understands their own children under the age of ten count towards capacity. Licensee 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 7 days to remain in compliance. LPA discussed Type A/B citations, open door policy, fire drills, children’s personal rights, and smoking policy with the applicant.

PAGE 1. REPORT CONTINUES ON LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Julia Maryanova
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: SAMIMI, AREFA
FACILITY NUMBER: 343626667
VISIT DATE: 04/23/2025
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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, 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.

On this date, February 10, 2025, 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.

Licensee 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).

Applicant was informed of the www.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.

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://cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

PAGE 2. REPORT CONTINUES ON LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Julia Maryanova
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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: SAMIMI, AREFA
FACILITY NUMBER: 343626667
VISIT DATE: 04/23/2025
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LPA discussed CCR Regulation 102416.5 regarding staffing Ratio and Capacity for a large license.

LPA discussed personnel requirements and records outlined in CCR Regulations 102416 and 102416.1.

Licensee understands that when an assistant is not present, she must comply with the capacity and ratio requirements for a Small Family Child Care Home.

Effective today, 04/23/2025, the facility is approved for a large capacity to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years.

This facility evaluation report was reviewed and discussed with the licensee Arefa Samimi. A Notice of Site Visit was provided and should remain posted for 30 days for parental review.
NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Julia Maryanova
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC809 (FAS) - (06/04)
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