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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343627062
Report Date: 08/29/2025
Date Signed: 08/29/2025 10:32:28 AM

Document Has Been Signed on 08/29/2025 10:32 AM - 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:NURISTANI, AISHADFACILITY NUMBER:
343627062
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/29/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Nuristani, AishaTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analysts (LPA) Pa Dao Vang met with Nuristani, Aishad upon her request for a change of location and capacity increase for the Family Childcare Home license. The previous change of location facility number is 376101842.

The current facility will operate Monday to Friday 6:00 AM- 10:00 PM. LPA confirmed that all adults residing and working in the home have a criminal record clearance through Community Care Licensing. Applicant’s husband was also present and translating in Pasto during the inspection. Applicant understands she must be present at the facility for 80% of operating hours.

The Licensee lives in a one-story home with two bedrooms, one bathroom, kitchen/dining room, living room, shed, backyard, gated front yard, and garage. Off Limit Areas included: bedroom #1, garage, shed, and front yard. LPA observed a working 2A-10-BC fire extinguisher and working combination of a smoke detector and carbon monoxide detector. Toys and the home appear to be safe and appropriate for children. Cleaning materials, hazardous items, and medications are all stored inaccessible to children. LPA also observed a first aid kit in the facility.

Applicants have a valid CPR/First Aid certificate that will be expired on 11/2025. Applicant is exempt from Mandated Reporter Training certificated due to language barriers. Applicant provided a copy of the rental agreement to LPA.

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: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2025
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 3
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: NURISTANI, AISHAD
FACILITY NUMBER: 343627062
VISIT DATE: 08/29/2025
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A health and safety inspection of the interior and exterior of the home was conducted. Chemicals, knives, medications, and hazardous items are all stored in a way that is inaccessible to children. LPA discussed the required documents for the postings in the home. License stated that there's no smoking, no firearm, poison in the home. LPA discussed about 100% supervision around any bodies of water.

Applicant understands to pay the annual fees of $140.00 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

On this date, 6/11/2025, 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.

The Facility Evaluation Report was reviewed and discussed with the Applicant. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

As of Friday, August 29th, 2025, the facility is approval for a change of location and a Large Family Child Care Home license, with a capacity of a maximum capacity (when there is an assistant present) of 12 children with no more than four infants OR a capacity of 14 children no more than three Infants; one child must be in Transitional Kindergarten/Elementary School and one child must be at least six years old. If there is not an assistant present, the facility must revert to a Small Family Child Care Home license. An exit interview conducted, and report was reviewed with Applicant, Aishad Nuristani.

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

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
LIC809 (FAS) - (06/04)
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