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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500877
Report Date: 06/22/2023
Date Signed: 06/22/2023 03:11:17 PM

Document Has Been Signed on 06/22/2023 03:11 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:YOUSUFZAI, NAJIBAFACILITY NUMBER:
344500877
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/22/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Najiba YousufzaiTIME COMPLETED:
03:30 PM
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On 06/22/2023 at 1:00 PM, Licensing Program Analyst (LPA) Tiffanie Diep and Office Technician (OT) Khatera Jamil met with Applicant Najiba Yousufzai for the purpose of a pre-licensing inspection. LPA and OT were accompanied by Applicant during the inspection. Applicant’s primary language is Farsi and OT assisted with translation during the inspection. Applicant's tentative operating hours are Monday through Friday from 6:00 AM to 9:00 PM. Applicant provided proof of control of property.

A health and safety inspection of the home’s interior and exterior was conducted. The two-story home has a living room, dining room, kitchen, and bathroom on the first floor. There are three bedrooms, two bathrooms, and laundry room on the second floor. LPA and OT verified all knives and toxic and hazardous items were inaccessible to children. LPA and OT observed cleaners stored in laundry room out of reach and inaccessible to children. Functioning smoke and carbon monoxide detectors were observed in the living room at the base of the stairs. A 2A10BC fire extinguisher was observed in the living room and first aid kit was observed in the kitchen. Applicant stated there are no weapons or pets in the home. LPA and OT observed a fireplace that was barricaded by a glass and mesh screen. Applicant stated the front panel does not get hot. LPA observed Applicant touch the front panel. Applicant stated they will not use the fireplace and will maintain supervision to ensure children's safety. The outdoor play area was inspected and is surrounded by a wooden fence. LPA walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. LPA and OT did not observe bodies of water on the premises.

The off-limits area in the home include the entire second floor. Applicant understands off-limits areas will remain inaccessible to children in care by baby gates and supervision. LPA and OT observed stairs to the second floor barricaded by a baby gate. Applicant understands that if any structural changes are made to the home, Licensing must be notified prior to construction. Applicant also understands that Licensing must be notified prior to use of any off-limits area and an inspection must be completed by an LPA before children are allowed in the area.
Continues on 809-C
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YOUSUFZAI, NAJIBA
FACILITY NUMBER: 344500877
VISIT DATE: 06/22/2023
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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 five 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 05/16/2023, 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 (RSOs) were found at the facility addresses. Under state law, some RSOs 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 RSOs against all Community Care Licensing Division (CCLD) facility addresses pursuant to information shared by California DOJ.

LPA and OT discussed the mandated reporter training requirement with Applicant. Health and Safety Code section 1596.8662 requires all licensed child care providers, applicants, administrators, and employees of a licensed child care facility to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicant’s current Mandated Reporter Training certificate expires on 03/26/2025. Current pediatric CPR and first aid training was verified and expires on 03/18/2025. LPA discussed the requirement to renew CPR and first aid certifications every two years prior to expiration. Completion of preventative health and safety training including nutrition and lead exposure was verified.

Continues on 809-C
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YOUSUFZAI, NAJIBA
FACILITY NUMBER: 344500877
VISIT DATE: 06/22/2023
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LPA and OT discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA and OT 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 and OT discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months. LPA provided a copy of the Individual Sleeping Plan (LIC 9227) for infants under 12 months.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

LPA and OT reviewed with Applicant the Forms/Records To Keep In Your Family Child Care Home (LIC 311D), children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist (LIC 9280) was provided to Applicant. Applicant understands that records for children and staff, including a current children’s roster, are to be maintained according to Title 22 Regulations and accessible to Licensing for up to three years. Proof of required immunizations for Applicant was verified. Applicant understands that fire and disaster drills must be conducted and documented once every six months. Applicant understands that if an unusual incident occurs, a report shall be made to the Department by telephone, e-mail, or fax within 24 hours and the Unusual Incident/Injury Report - Family Child Care Home (LIC 624B) shall be submitted within seven days to remain in compliance. Applicant understands that licenses are not transferrable, and once licensed, the licensee must live in the home and be present for 80% of the operating hours.

Continues on 809-C
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: YOUSUFZAI, NAJIBA
FACILITY NUMBER: 344500877
VISIT DATE: 06/22/2023
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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://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive e-mail communication.

Applicant was encouraged to visit CCLD’s website at http://ccld.ca.gov/ for information regarding child care updates, forms, regulations, and legislation pertaining to Community Care Licensing. 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.

A license for a small Family Child Care Home is granted effective today, June 22, 2023. The facility is approved to serve a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child enrolled in transitional kindergarten or above, and 1 child at least age 6. Infants are children under the age of 2.

An exit interview was conducted and report was reviewed with the applicant, Najiba Yousufzai.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
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