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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101153
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:36:05 PM

Document Has Been Signed on 06/28/2022 12:36 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:HASHEMI, MAHDIA FAMILY CHILD CAREFACILITY NUMBER:
376101153
ADMINISTRATOR:MAHDIA HASHEMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 654-2011
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 1DATE:
06/28/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Mahdia Hashemi and Fraidoon HashemiTIME COMPLETED:
12:40 PM
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On 06/28/2022 at 10:45am, Licensing Program Analyst (LPA) Selina Siao conducted an announced change of location Pre-Licensing with the applicant Mahdia Hashemi and her husband Fraidoon Hashemi (translator in Farsi). The 3 bedroom, 2.5 bath home was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fully charged fire extinguisher size 2A10BC and an operating smoke detector. All hazardous items were latched/locked and secured out of reach of children during today's inspection. There are no bodies of water or weapons in the home. Applicant's EMSA approved CPR and First Aid cards are current due to expire on June 2024 and she completed the 8 hours preventative health practice course on 06/18/2022. Applicant completed the online mandated child abuse training on 06/21/2022. A review of staff records on this date indicates that applicant and her husband are the current adults that lives at the home both has the required background clearances, immunization and TB clearances. Applicant and her husband owns the property and has provided control of the property.
Applicant will be using the following areas for childcare: living room, 1/2 bath sink located inside the living room, dining area, kitchen, family room, office room and bathroom. Off limit areas include: master bedroom/bath, bedroom #1 and bedroom #2, laundry room and detached garage, front yard and patio deck areas. The home has some toys but more will be move to this home once the home obtain fire clearances. The children will be playing in the backyard and supervision is needed when children are outside.
LPA discussed the following information to applicant: children’s records, child abuse, unusual incident reporting, immunization, adults living or working in the home and associated civil penalties, shaken baby syndrome, SIDS, car seat law, healthy beverage and heat related illness information. Applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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: HASHEMI, MAHDIA FAMILY CHILD CARE
FACILITY NUMBER: 376101153
VISIT DATE: 06/28/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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

Applicant shall comply with all regulations and laws governing family child care homes and be financially secure to operate a family child care home for children. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress.

All unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203.

LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

The following corrections are needed prior to granting a license:
  • latch for the sliding door near the kitchen that leads to the off limit patio areas
  • gate side of the back yard that leads to the front drive way to ensure children's safety
  • post all the required licensing postings
  • all off limit areas for the three bedrooms and the door located in the living room needs safety latch or door knob cover to prevent access
  • carbon monoxide detector is needed for the home (video)
  • immunization TDAP for applicant's husband/helper
  • large license fire clearance


Applicant shall submit pictures and videos of the above corrections to LPA within 5 days.

This report has been translated to applicant by her husband in Farsi.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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