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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101188
Report Date: 08/10/2022
Date Signed: 08/10/2022 02:47:37 PM

Document Has Been Signed on 08/10/2022 02:47 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:KOHISTANI, NASIMA FAMILY CHILD CAREFACILITY NUMBER:
376101188
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/10/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Applicant, Nasima Kohistani TIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Jennifer Lott, conducted an announced Pre-Licensing Inspection. LPA was greeted at the front door by Applicant, Nasima Kohistani and granted entry after identifying herself and disclosing the purpose of her visit. Daughter, Zala Kohistani provided translating service as the licensee speaks Pashtu. The applicant has applied for a capacity of eight (8). The home consists of four bedrooms and 2 1/2 bathrooms. The applicant will be using the following areas for daycare: Living room, kitchen, bathroom/bedroom #1. Off limit areas include: Bedroom/bathroom #2, bedroom 3&4, front yard, back yard and garage and laundry room. Business Hours are Monday through Friday. 7am to 10pm. An overall inspection of the home was conducted. The inspection included, but was not limited to:

The home has a functioning carbon monoxide / smoke detector and fire extinguisher that meet statutory requirements. Fireplace is screened to prevent access by children. Storage areas for poisons, detergents, cleaning solutions, medications and items which state keep out of reach of children have been locked and inaccessible to children. There are no pools or bodies of water. Applicant, Kohistani advised there are no firearms or ammunition stored on the premises. The home is kept clean with heating and ventilation for safety and comfort. Where children less than 5 years old are in care, stairs are fenced and/or barricaded. The home provides safe toys, play equipment and materials. The licensee has completed training on preventative health practices including pediatric CPR and First Aid. Staff immunization were reviewed and in compliance. There is a working phone and email address.

LPA reviewed with applicant, 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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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: KOHISTANI, NASIMA FAMILY CHILD CARE
FACILITY NUMBER: 376101188
VISIT DATE: 08/10/2022
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The new provider packet was reviewed with the applicant including information on immunizations, child abuse reporting, car seat laws, shaken baby syndrome, SIDS,and the effects of lead poisoning. Applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall not be permitted during daycare operation. All equipment that is used should be used only as intended by the manufacturer. Applicant Kohistani states they are aware that interference with a child’s daily functions, physical or mental abuse and corporal punishment is not permitted. LPA and applicant discussed California Megan’s Law and LPA provided the link www.meganslaw.ca.gov.

LPA discussed safe sleep regulations with the applicant, 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. LPA also informed the applicant 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 CPSC to be notified of any recalls on their purchased equipment.

LPA discussed the following with the applicant: Maximum capacity for a small family child care home; 4 infants only (infants defined as children under 24 months) or 6 children with no more than 3 infants; or with landlord consent, 8 children with no more than 2 infants – 1 child in kindergarten or elementary school and 1 child at least age 6 including children under the age of 10 who reside in the applicant’s home.

Applicant 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, 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 minimum/day up to $500 maximum per day/per person will be assessed if the regulation is violated.

LPA provided the applicant with the following: Child Care Advocates email address of childcareadvocatesprogram@dss.ca.gov.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
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: KOHISTANI, NASIMA FAMILY CHILD CARE
FACILITY NUMBER: 376101188
VISIT DATE: 08/10/2022
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Incidental Medical Services (IMS) policy was discussed. 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)/ (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 communication platform. To receive important licensed-related information to licensed facilities, 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 communication.

No corrections are needed at this time. A license for eight (8) children will be granted upon final file review. Applicant agrees to comply with all regulations and laws governing Family Child Care Homes. Additional Technical Assistance was provided and noted on the attached Advisory Note – Technical Assistance (LIC 9102).

Exit interview conducted and report was reviewed with Applicant, Kohistani.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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