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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100979
Report Date: 04/17/2023
Date Signed: 04/17/2023 12:38:26 PM

Document Has Been Signed on 04/17/2023 12:38 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:SHARIF, FOROUGHALSADAT FAMILY CHILD CAREFACILITY NUMBER:
376100979
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
04/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Licensee Foroughalsadat SharifTIME COMPLETED:
12:45 PM
NARRATIVE
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On 4/17/2023 @ 11:55 a.m., Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to evaluate the facility for a requested increase in capacity. The application was received on 3/1/23 and the fire clearance was granted on 3/27/23.

LPA toured the home. The day care areas remain the same and the facility sketch is current. There were five children present, napping at the time of the visit. There were two children under the age of two years in pack and plays in the main room. Safe sleep regulations were being followed today. LPA verified that the spa in the backyard is locked and inaccessible. During today's visit, LPA reviewed a sample of children's records and found them to be complete. The roster was current and complete. Licensee had it posted. LPA advised her to keep the document in a safe, place but not posted as it contains confidential information. Fire extinguisher, smoke alarm and carbon monoxide detector are in compliance. Capacity limitations were reviewed and handout provided. Licensee states that her spouse will be her assistant for the large family home. LPA provided a copy of the personnel requirement regulation. She understands that she may not operate at a large family capacity if there is no assistant present. Both Licensee and her spouse have the required vaccination information, current CPR/FA certification and current Mandated Reporter certificates on file. LPA evaluated an infant play item in the child care room. (see photo in file.) Licensee demonstrated that the item does not have wheels, does not bounce or roll and the chair does not turn.

Licensee has not conducted an emergency drill and stated that she wasn't sure what that was. LPA explained and a drill will need to be conducted and logged prior to approval of the increase in capacity. A Type B deficiency is being cited today on the accompanying LIC 809D.

NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2023
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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Document Has Been Signed on 04/17/2023 12:38 PM - It Cannot Be Edited


Created By: Joelle Redding On 04/17/2023 at 12:18 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: SHARIF, FOROUGHALSADAT FAMILY CHILD CARE
FACILITY NUMBER: 376100979

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2023
Section Cited
CCR
102417(g)(9)(A)

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Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child....Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement was not met as evidenced by
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Upon explaination of a disaster drill, Licensee stated that she will conduct a drill by the end of the week, log it and send a copy to Licensing as verification of correction. She states that she understands that the increase in capacity will not be granted until the correction is completed and verified by Licensing.
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Based on interview with Licensee and record review, Licensee stated she did not know what a fire or disaster drill was and has not conducted one. This poses a potential hazard to children in care.
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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:Renesha Askew
LICENSING EVALUATOR NAME:Joelle Redding
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2023


LIC809 (FAS) - (06/04)
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