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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372015741
Report Date: 07/30/2024
Date Signed: 07/30/2024 12:29:16 PM

Document Has Been Signed on 07/30/2024 12:29 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RAJPUT, IRFANA FAMILY CHILD CAREFACILITY NUMBER:
372015741
ADMINISTRATOR/
DIRECTOR:		IRFANA RAJPUTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 484-7621
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
07/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Irfana RajputTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On 7/30/24 at 11:40am., Licensing Program Analysts, Annette Sutherland and Mahjoba Raofi, met with licensee Irfana Rajput also present was Helper Parwean Sadat. LPAs made an unannounced visit to follow up on a self-reported incident that occurred on 5/23/24, where a 21-month-old child at the time (Child #1) fell getting down from the wrong side of Jungle gym.

Based on the information obtained during interviews with RP and review of relevant documentation. Play equipment was not age appropriate at the time per manufacture guidelines. Jungle gym is for ages 2–5-year-olds.

This is a potential hazard to children in care and a Type B deficiency will be cited on the accompanying LIC 809D.

Notice of Site Visit was given and will remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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Document Has Been Signed on 07/30/2024 12:29 PM - It Cannot Be Edited


Created By: Annette Sutherland On 07/30/2024 at 12:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: RAJPUT, IRFANA FAMILY CHILD CARE
FACILITY NUMBER: 372015741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2024
Section Cited
CCR
10241(d)

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102417 Operation of a Family Child Care Home.(d) The home shall provide safe toys, play equipment and materials. This requirement was not met as evidenced by:
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Licensee understands to use equipment according to manufacture guidance.
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Based on self reported information obtained by licensee. Jungle was not age appropriate. Child #1 was 21 months old. Equipment is for ages 2 - 6 year olds.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joelle Redding
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024


LIC809 (FAS) - (06/04)
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