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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101081
Report Date: 07/08/2022
Date Signed: 07/08/2022 11:02:45 AM

Document Has Been Signed on 07/08/2022 11:02 AM - 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:HAIDARI, LAILA FAMILY CHILD CAREFACILITY NUMBER:
376101081
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
07/08/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Laila HaidariTIME COMPLETED:
11:15 AM
NARRATIVE
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 On 7/8/22 at 9:14am Licensing Program Analyst, Patrick Ma conducted an unannounced Case Management visit for an increase in capacity from eight (8) to fourteen (14) children. LPA was greeted at the front door by Licensee, Laila Haidari. Also present was adult son, Tawsiqahma Haidari who helped translate, and 3 own minor children.

On 5/12/22, the licensee submitted an application (LIC 279) to request an increase of capacity. The Fire Safety Inspection Report (STD 850) was sent to LPA Ma on 6/1/22 and was approved by the local fire marshal and granted the capacity increase to fourteen (14) children.

The 4 bedroom, 3 bathroom 2 story home was toured and inspected to ensure an environment safe for the care and supervision of children. Licensee will be using the living room, dining room, kitchen, 1st floor bathroom, and backyard for child care. Off limit areas is the entire upstairs and garage and are inaccessible by use of child safety gate at bottom of stairs and doorknob cover for garage. Back yard is fully fenced, licensee was advised to provide supervision at all times when children are outdoors.

The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water on the property. Applicant states that there are no weapons in the home. Children’s and Staff records were reviewed.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HAIDARI, LAILA FAMILY CHILD CARE
FACILITY NUMBER: 376101081
VISIT DATE: 07/08/2022
NARRATIVE
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Licensee was reminded of the staffing/capacity ratios for Large Family Child Care Homes. Twelve (12) children, no more than 4 infants (birth to 24 months) and 8 older children over the age of 2. A qualified assistant (age 14 or older) is required. For fourteen (14) children, no more than 3 infants (birth to 24 months) and 11 older children; at least 2 school age, 1 child at least age 6, 1 child enrolled in and attending kindergarten or elementary school. Landlord consent and written parent notification are required when caring for more than 12 children. When there isn't a qualified assistant, licensee must follow Small Family Home Child Care Regulations.

See LIC809D for deficiencies cited.

The following corrections are needed.
• Completed helper packet for Tawsiqahma Haidari
• Completed children’s files for 3 out 3 children

Applicant understands that corrections must be submitted to the Department within 30 days or the application may be denied.

Exit interview conducted and report was reviewed with the applicant Laila Haidari.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/08/2022 11:02 AM - It Cannot Be Edited


Created By: Patrick Ma On 07/08/2022 at 10:09 AM
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: HAIDARI, LAILA FAMILY CHILD CARE
FACILITY NUMBER: 376101081

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2022
Section Cited
CCR
102416.1

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102416.1
Personnel records shall be maintained on each employee...
This requirement was not met as evidenced by:
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Licensee states she will submit all employee files for Tawsiqahma Haidari to LPA Ma via email by 8/8/22.
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Based on file review, the licensee did not have any employee records on file for helper Tawsiqahma Haidari when he stated he "helped pick up" the children on 7/5/22 which poses a potential health and safety risk to children in care.
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Type B
07/08/2022
Section Cited
CCR102421(a)

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102421(a) Childs Records. The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
This requirement was not met as evidenced by:
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Licensee states she will have the parents sign the forms and submit a copy of the forms to LPA Ma by 8/8/22 via email at patrick.ma@dss.ca.gov.
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Based on file review, Licensee did not have signed LIC 700, LIC 995, LIC 282, and LIC 627 for 3 out of 3 children enrolled in care which poses a potential hazard to the health and safety of children in care if not corrected.
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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:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2022


LIC809 (FAS) - (06/04)
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