344500768-3-14-2023-53-CC-SMAY-CPWTG6-20230314144238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500768
Report Date: 03/14/2023
Date Signed: 03/14/2023 02:42:44 PM

Document Has Been Signed on 03/14/2023 02:42 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	SAFI, NAZIFA		FACILITY NUMBER:	344500768
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	03/14/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Nazifa Safi		TIME COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Salene Mayberry met with Licensee, Nazifa Safi, for the purpose of conducting a case management inspection to increase the facility capacity from a Small to a Large Family Child Care Home. Present during the inspection was Licensee's husband and three adult children. Licensee's primary language is Pashto. During today's inspection, Licensee's son, Azimullah, helped the Licensee with translation. A fire clearance was granted by Cosumnes Community Services District Fire Department on 3/8/2023. LPA observed no present in the home with Licensee. The hours of operation are 7:00 am to 5:30 pm Monday through Friday. All adults living and working in the facility have a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, 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. The facility is two story home that consists of 4 bedrooms, and 3 bathrooms. LPA and Licensee toured all areas accessible to children in the home. Upon entry, LPA observed the posting of the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist and Notification of Parent Rights. Licensee has a 2A10BC fire extinguisher, and a first aid kit located in the living room. Smoke alarm and carbon monoxide detectors were observed to be in operational order. Hazardous and personal hygiene items are inaccessible to children in care. Sharp utensils are stored on upper shelf in the kitchen. LPA observed a fireplace that was appropriately barricaded. The stairs in the home are also appropriately barricaded with a child gate to prevent access. Licensee stated there are no weapons in the home. Report continued on LIC809C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: SAFI, NAZIFA	FACILITY NUMBER: 344500768
	VISIT DATE: 03/14/2023

NARRATIVE

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LPA discussed with Licensee the Mandated Reporter training and the requirement that it must be renewed every two years. A Current pediatric CPR and first aid training was verified and expires 8/6/2024. The outdoor play space is currently off limits as the fence was damaged in the storms. Licensee stated that it is scheduled to be repaired by the end of the month. There are no bodies of water on the premises.

Off limit areas consist of the garage, backyard, and entire second floor. Licensee acknowledged that children are never allowed in the off-limit areas. Off limit areas will remain inaccessible by gates, locked doors and supervision.

LPA discussed safe sleep regulations and the requirement to check and log napping infants 24 months and under every 15 minutes. LPA provided the Child Care Licensing Safe Sleep webpage as an additional resource: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.

LPA provided Licensee a copy of Forms/Records to Keep in Your Family Child Care Home (LIC311D) and discussed licensing requirements with Licensee including the posting of licensing inspection notices and reports, as well as injury and incident reporting. LPA reminded Licensee that if any structural changes are made to the home, Licensing must be notified prior to construction. Finally, Licensee understands that licenses are not transferable, and once licensed, Licensee must live in the home and be present for 80% of the operating hours.

Licensee currently does not have any children enrolled that require Incidental Medical Services (IMS). LPA discussed IMS services and the requirement to create a plan for providing IMS. Licensee acknowledges that if any IMS is provided in the future, a plan must be submitted to Licensing.

LPA provided the contact information for the ADA: 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.

Report continued on LIC809C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: SAFI, NAZIFA	FACILITY NUMBER: 344500768
	VISIT DATE: 03/14/2023

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Licensee was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

An exit interview was conducted, and the report was reviewed with the Licensee.

Effective today 3/14/23, the facility is approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without assistant, the ratios revert to those for small family childcare home.

A Notice of Site Visit was posted by LPA and Licensee acknowledges it must remain posted for 30 days, and that a failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC809 (FAS) - (06/04)

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