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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626766
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:46:15 PM

Document Has Been Signed on 03/11/2025 03:46 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:ANDAR, HAJERAFACILITY NUMBER:
343626766
ADMINISTRATOR/
DIRECTOR:
ANDAR, HAJERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 492-1102
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/11/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Hajera AndarTIME VISIT/
INSPECTION COMPLETED:
10:10 AM
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This is a Change of Location from previous facility #343625109.
On Tuesday, March 11, 2025, Licensing Program Analyst (LPA) Tanya Washington conducted an announced Pre Licensing/ Change of Location inspection and met with applicant Hajera Andar. Applicant's son Ajmal Andar assisted with interpretation from English to Dari. Also present in the home is Applicant's adult son Mohammad Andar, there were no children present during today's inspection. LPA conducted a health and safety inspection of Applicant's home inside and out. Facility hours of operation will be Monday- Friday from 6 AM to 10 PM.

Applicant has requested a fire clearance from Sacramento Metropolitan Fire District and currently awaiting approval.

This facility is a single story home which has three bedrooms, two bathrooms, living room, kitchen, garage and a fenced backyard. Off limit areas will include: last bedroom on the left side of the hallway with an attached bathroom, last bedroom in the hallway on the right and garage. Applicant stated she understands that children may not enter off limits areas and any changes made must be cleared through Licensing. Chemicals, knives, medications, and hazardous items are all stored in a way that is inaccessible to children.

Applicant rents this home and copy of the rental agreement was provided with the application. Because the applicant rents the home, proof of landlord notification is required. Applicant submitted signed form LIC9151 confirming that the landlord was verbally informed that childcare will be provided. Applicant has obtained permission from the landlord to be able to provide care to 14 children and provided signed LIC9149.

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, 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.

Continued on LIC809C
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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: ANDAR, HAJERA
FACILITY NUMBER: 343626766
VISIT DATE: 03/11/2025
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Fireplace located in the living room is properly barricaded and will no be used during daycare hours. There are no poisons in the home. LPA observed the smoke and carbon monoxide detector are functioning properly. LPA observed a 2A-10-BC fire extinguisher. Applicant stated that there are no weapons in the home. Applicant understands that related children under the age of 10 count as part of the ratio/ capacity. There are no bodies water on the premises.

LPA discussed with Applicant the safe sleep regulations and 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.

Incidental Medical Services- IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.htm.

LPA provided the Department’s website WWW.CCLD.CA.GOV, so the Applicant can obtain updated licensing information, new regulations and access forms. LPA advised Applicant of their responsibility to stay current by reviewing PINs on the website.

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.

Prior to licensure applicant must provide the following:
- Copy of rental agreement for current location
- Fire clearance from Sacramento Metropolitan Fire Department
- Provide proof of current CPR and First Aid Certificate
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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