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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626711
Report Date: 04/08/2025
Date Signed: 04/09/2025 02:07:11 PM

Document Has Been Signed on 04/09/2025 02:07 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:HABIBI, BIBI SOHAILAFACILITY NUMBER:
343626711
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
04/08/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Habibi, Bibi Sohaila TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On March 11th, 2025, at 12:30 PM, Licensing Program Analyst (LPA) Pa Dao Vang met with Applicant, Bibi Sohaila Habibi, for a scheduled pre-licensing for a change of location. Applicant was previously licensed under facility #343625926. Applicants received permission from the landlord to operate a Family Child Care home. The LIC9149 Property Owner/Landlord Consent was obtained to operate up to 8 children at a time. Applicants understand their own children under ages 10 years old counts into the ratio during facility hours.

LPA and applicant toured the entire home inside and out. Applicant had pre-licensing forms from previous licensed location. LPA explained about obtaining $300,000 liability insurance. Applicant understands that until a policy is obtained, she must use the affidavit form LIC282. Applicant’s hours of operation are planned to be 7:00 AM to 9:30 PM hours through Mondays thru Fridays. Applicant agrees to notify licensing if her days of operation will change, or another job is obtained.

During the inspection applicant’s 1 children were present during the inspection, who is over the age of 10 years old. Applicant is also living at the other facility #343625926 and operating with care with 10 children enrolled.

Applicants have certificates of completion for 15 hours of health, safety training including CPR/First Aid with expiration date of 1/11/2026. Licensees is reminded the CPR/ First Aid Training must be renew once every 2 years. Licensees are exempt from Mandated Reporter Training due to the training not provided in Dari.

Report continued on LIC809-C…
NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Dao Vang
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2025
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 6
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: HABIBI, BIBI SOHAILA
FACILITY NUMBER: 343626711
VISIT DATE: 04/08/2025
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Applicant and her husband obtained background clearance. LPA observed an unidentified adult residing in a mobile home on the side of the home. Applicant’s husband explained that the mobile home is off limit for them and one person lives in it. Applicants was reminded that all adults 18 and over living or working in the home address, including employees, volunteers, other adults, 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.

This facility is a one-story home and consists of 3 bedrooms, 2 bathrooms, laundry room, kitchen, dining room, living room, front yard, backyard with shed, and swimming pool. LPA was unable to view the shed located in the backyard. Applicant’s husband explained he’ll obtained the key from the Landlord to access the shed for LPA to view it during next pre-licensing inspection. LPA also inspected the fencing around the swimming pool. LPA observed a wooden gate facing the pool with an opening on the bottom with more than 7 inches opening from the ground. Applicant’s husband will fix the bottom with a wooden gate to lessen the opening on the bottom of the gate to meet regulation. The pool alarm is ASTM F2208-2008 standard, in which meets regulation requirement. The pool cover is F1346-91 standard, in which do not meet the regulation of ASTM International Standard F1346-23. LPA also observed the two life rings with a diameter of at least 17 inches, in which do not have the United States Coast Guard approval label. Applicant will look for another life ring that have the approval label. LPA observed a rescue pole with a body hook that is at least 12 feet long. LPA observed the gate into the pool not meeting regulation, in which is not self-latching and lockable device that is no lower than 60 inches above the ground. Applicant will put a new lock and fix the self-latching on the gate. LPA also reviewed the pool cover, pool alarm, pool enclosure and daily pool inspection regulation with applicant.

Off limit areas includes the dining room, kitchen, bedroom #2, bedroom #3, laundry room, swimming pool area, and front yard. Applicants understands they must notify licensing for any modification inside and out of the home. There is a gate between the dining room and the living room to prevent children from accessing it.

Continue report on LIC809-C...
NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Dao Vang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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: HABIBI, BIBI SOHAILA
FACILITY NUMBER: 343626711
VISIT DATE: 04/08/2025
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LPA reviewed the requirement of maintaining a fire drill log and a children’s roster. There is a fireplace in the home but Applicant is not using it. Applicants stated there are no weapons, smoking, and/or poison in the home. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Hazardous cleaning compounds and knives, and medications are inaccessible to children. LPA also reviewed appropriate toys, infant cribs, and materials for children under Title 22 regulations.

Applicants understands that 100% supervision is required in any unfenced areas. Applicants also agreed to provide 100% supervision around bodies of water. Applicants understands that 100% supervision is required in any unfenced areas.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep web page 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. LPA reviewed the 15 minutes logs for infant care in the facility with Applicant. Infant safe sleep regulations were also reviewed with Licensees.

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)/ (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.html

Report continued on LIC809-C…

NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Dao Vang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: HABIBI, BIBI SOHAILA
FACILITY NUMBER: 343626711
VISIT DATE: 04/08/2025
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Applicant understands to pay the annual fees of $73.00 before the due date. The annual bill will be sent through the mail with facility number, pin, and the amount of it. Applicant can pay it through the department website at https://cdss.ca.gov/inforesources/community-care/licensing-fees . They may also pay in person in our office or mailing with check/Money Order/personal check to the address listed below:

CA Department of Social Services
MS 9-3-67
P.O. Box 944243
Sacramento, CA 94244-2430

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the Applicants can obtain updated licensing information, new regulations and access forms. LPA advised Applicants of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

LPA confirmed that the Applicants have all licensing forms from previous licensed facility. LPA reviewed and answered questions applicant has regarding the forms.

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.

Continue report on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Dao Vang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: HABIBI, BIBI SOHAILA
FACILITY NUMBER: 343626711
VISIT DATE: 04/08/2025
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Applicant also requested to add her husband as a co-licensee to the change of location application. Applicant filled out a copy of the LIC279 FCCH application for LPA.

As of April 8th , 2025, the facility is pending for approval with a Small Family Child Care Home license, with a capacity of 6 children with no more than 3 infants, or 4 infants only. The maximum capacity of 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of two years. Applicant obtained a copy of Landlord Consent form in file.

Pending items:

1. Applicant will obtain the key from the Landlord to access the shed for LPA to view it during next pre-licensing inspection.


2. Applicant will get the unidentified adult fingerprinted at a Live Scan Center.
3. Applicant will show proof of the unidentified adult’s TB.
4. Applicant will put a new lock and fix the self-latching on the gate of the swimming pool.

5. Applicant will fix the bottom with a wooden gate facing the swimming pool to lessen the opening on the bottom of the gate to meet regulation.


6. Applicant will obtain a life ring that have the United States Coast Guard approval label.
7. Pending approval for manger LPA Seychelle De Luca’s approval.
NAME OF LICENSING PROGRAM MANAGER: Seychelle De Luca
NAME OF LICENSING PROGRAM ANALYST: Dao Vang
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6