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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344501085
Report Date: 04/08/2024
Date Signed: 04/08/2024 12:06:34 PM

Document Has Been Signed on 04/08/2024 12:06 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KHAN, BIBI ASIAFACILITY NUMBER:
344501085
ADMINISTRATOR/
DIRECTOR:		KHAN, BIBI ASIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 247-1305
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/08/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Bibi Asia KhanTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 04/08/2024, Licensing Program Analyst Katy Velazquez (LPA) met with Applicant Bibi Asia Khan (A1) for the purpose of a Change of Location and Change of Capacity inspection. A1 was previously licensed under the North Regional Office; facility number #343624773. LPA disclosed the purpose of the inspection and was granted entrance into the Family Childcare Home (FCCH). LPA provided the Entrance Checklist to A1. Also present in the FCCH was A1's husband, A1's minor infant and child, and 2 minor guests. A1’s primary language Pashto. LPA utilized Focus Language International Inc. for translation services during today’s inspection. A1’s tentative hours of care are 7 days per week from 8:00 AM until 8:00 PM. A1 does not intend on providing overnight care. A1 obtained Fire Clearance on 03/26/2024, and a copy of the Clearance was provided to the Regional Office.

All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. On 02/23/2024, 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 address. 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.

Since A1 rents/leases the home, proof of landlord notification is required and was provided. LPA observed the Property Owner/Landlord Notification form (LIC9151) that A1 confirmed was provided to the property owner/landlord. A health and safety inspection was conducted inside and outside of the FCCH. A1 accompanied LPA for the entirety of the tour. The FCCH is a two story house. The first floor consists of the kitchen, living room, bathroom, and access to the garage.

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SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KHAN, BIBI ASIA
FACILITY NUMBER: 344501085
VISIT DATE: 04/08/2024
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The second floor consists of a bathroom, 3 bedrooms, master bedroom and bathroom, and laundry room. LPA verified that toxic and hazardous items were inaccessible to children in care. LPA observed a staircase that was barricaded by a baby-gate, making the stairs in accessible to children in care. LPA toured the OFF-limits backyard and observed that entirety of the backyard was fenced-in. LPA did not observe any bodies of water on the premises, and A1 confirmed that there were no bodies of water. A1 stated that she will utilize a local park for outside play. LPA explained to A1 that 100 percent supervision is required when day-care children are at the park. A1 stated that she does not own any pets. The OFF-limits areas of the FCCH are the entire second floor, garage, and backyard. A1 understands that OFF-limits areas must remain inaccessible to children in care. A functioning dual smoke and carbon monoxide detector was tested downstairs. LPA observed cleaners and detergents stored in the OFF-limits laundry room. LPA observed knives stored in a kitchen cabinet that are inaccessible to children in care. A 2A10BC fire extinguisher was observed in the kitchen and appeared to be in the green zone. A first-aid kit was observed in the kitchen. A1 stated there are no firearms in the FCCH.

LPA discussed Mandated Reporter Training with A1. Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees complete training as specified on Mandated Reporter duties and to renew training every 2 years. Volunteers are encouraged but not required to take the training. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at http://www.mandatedreporterca.com. The training is currently provided in English and Spanish. A1 does not have a current Mandated Reporter Training Certificate as the training is not provided in her primary language. Current Pediatric CPR and First Aid training was verified for A1 and expires on 12/2024. Completion of Preventative Health and Safety training, including nutrition and lead exposure, was verified before the inspection. Proof of required immunizations for A1 was also verified before the inspection.

LPA discussed the Safe Sleep Regulations with A1 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.

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SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KHAN, BIBI ASIA
FACILITY NUMBER: 344501085
VISIT DATE: 04/08/2024
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 LPA also informed A1 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 discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months old. LPA provided a copy of the LIC 9227/Individual Sleeping Plan to be completed for infants under 12 months old.

Incidental Medical Services (IMS) policy was discussed with A1. 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: http://www.ada.gov/childqanda.htm.

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 by way of our communication platform. To receive important licensed related information, 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 communications.

A1 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.

A1 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 5-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.

A1 understands that licenses are not transferable, and once licensed, Licensee must live in the home and be present for 80% of the operating hours. A1 understands that if an unusual incident occurs; Licensing is to be notified via phone call, e-mail or fax within 24 hours and the LIC 624/ Unusual Incident Report shall be submitted within 7 days to remain in compliance. A1 understands that if any structural changes are made to the FCCH; Licensing must be notified PRIOR to construction. Continued on 809-C

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KHAN, BIBI ASIA
FACILITY NUMBER: 344501085
VISIT DATE: 04/08/2024
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A1 understands that if she wants to make any OFF-limits area an ON-limits area, she must notify Licensing and LPA must do an inspection BEFORE children are allowed in said area. A1 understands that children’s and staff’s records are to be maintained according to Title 22 regulations and be accessible to Licensing for up to 3 years. LPA reviewed with A1 the LIC 311D Forms/Records To Keep In Your Family Child Care Homes, Children’s Forms/Records, Facility Forms/Records, and Information to be Posted. A1 understands that fire drills must be conducted and documented once every 6 months.

As of today, 04/08/2024, A1 is approved for a Large Family Child Care Home licensed to serve 12 children (when there is an assistant present) with no more than 4 infants, or a capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above, and 1 child is at least aged 6 years with a maximum of 3 infants. Without an assistant, the ratios revert to those for Small Family Child Care Home.

An exit interview was conducted, and the report was reviewed with Applicant Khan. LPA provided Licensee Appeal Rights to A1. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024
LIC809 (FAS) - (06/04)
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