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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101188
Report Date: 07/01/2024
Date Signed: 07/01/2024 02:35:49 PM

Document Has Been Signed on 07/01/2024 02:35 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:KOHISTANI, NASIMA FAMILY CHILD CAREFACILITY NUMBER:
376101188
ADMINISTRATOR/
DIRECTOR:		NASIMA KOHISTANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 675-8581
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
07/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:49 AM
MET WITH:Nasima KohistaniTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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On 7/1/24 at 11:49 a.m., Licensing Program Analyst (LPA) Renita Rodriguez conducted an unannounced annual inspection with the Licensee. Upon arrival, LPA identified herself. LPA met with Licensee, Nasima Kohistani. The two story 4 bedroom 3 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Present in the home was licensee, licensee spouse Naserkhan Kohistani and Zala Kohistani (translator).

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include living room, kitchen, and bathroom all located on the 1st floor of the home. There is a fenced backyard available for outdoor activities. Off limits is the entire 2nd floor of the home and the garage. The 2nd floor is inaccessible by security gate located at the top and bottom of the stairs. The licensee has sufficient toys and play equipment available. The home has a fenced backyard available for outdoor activities.

The fire extinguisher (2A10BC), smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There is no body of water on the property. Licensee states that there are no weapons in the home. First Aid and CPR certifications expire on 8/2025. Licensee has required immunizations. Licensee completed Mandated Reporter Training 8/4/22 and is reminded it must be completed every 2 years. Children’s and Staff records were reviewed and found to be in order.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Renita Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: KOHISTANI, NASIMA FAMILY CHILD CARE
FACILITY NUMBER: 376101188
VISIT DATE: 07/01/2024
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 LPA also informed licensee 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 the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Type A

LPA Renita Rodriguez informed licensee Nasima Kohistani that this report dated 7/1/24 documents 102370(k)Type A citation. Type A citation which shall be posted for 30 consecutive days as the citation is an immediate risk to the health, safety, or personal rights of children in care.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Renita Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: KOHISTANI, NASIMA FAMILY CHILD CARE
FACILITY NUMBER: 376101188
VISIT DATE: 07/01/2024
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Also, LPA Renita Rodriguez informed the licensee Nasima Kohistani to provide a copy of this licensing report dated 7/1/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Civil Penalty

Please be advised that FAILURE TO PAY the required civil penalty payment may result in in the REVOCATION OF YOUR LICENSE. You must respond within 30 days with the payment of or a proposed payment plan that includes the first payment. Further, the Department will not approve any requests for increase in capacity or for additional capacity of additional licenses while civil penalties remain unpaid.

See LIC 809 D.

Exit interview conducted and report was reviewed with the licensee Nasima Kohistani.

During the exit interview, the Licensee Nasima Kohistani, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Renita Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/01/2024 02:35 PM - It Cannot Be Edited


Created By: Renita Rodriguez On 07/01/2024 at 02:10 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: KOHISTANI, NASIMA FAMILY CHILD CARE
FACILITY NUMBER: 376101188

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
102370 Criminal Record Clearance (d)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:

(1) Obtain a California clearance or a criminal record exemption as required by the Department


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with ensuring a criminal record clearance was obtained by adulit resident as the section cited above, which poses an immediate health, safety or personal rights risk to persons in care. In violation for more than 30 days.
POC Due Date: 07/02/2024
Plan of Correction
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Licensee states individual will submit fingerprints by 7/2/24. Licensee will ensure all adullts residing, working or have a prominent presence will be fingerprint cleared before their first date in the home or within 30 days of their 18th birthday if living in the home.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Renita Rodriguez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2024


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