<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101271
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:11:18 PM

Document Has Been Signed on 10/26/2022 12:11 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:HASHIMI, KHATERA FAMILY CHILD CAREFACILITY NUMBER:
376101271
ADMINISTRATOR:KHATERA HASHIMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 718-0874
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/26/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Khatera Hashimi TIME COMPLETED:
12:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/26/2022 @ 11:00 AM, LPA, Annette Sutherland, met with Applicant, for the purpose of a Pre-Licensing inspection for a change of location that was submitted on 9/6/22 and change of capacity. Fire clearance was granted on 9/19/22. LPA met with Licensee Khatera Hashimi. Also present was Licensee’s minor son and husband Sayed Hashimi who assisted with translation to Dari.

LPA toured the home. It is a two story, 4 bedroom, 3 bathroom home. Licensee will be using the living room, dining room, kitchen , bedroom #1 and #2, bathroom #1 and backyard. Off-limits areas include Bedroom #3 garage, laundry room, and entire upstairs which consists of master bedroom and master bathroom. The fireplace is secured, the stairs are gated and door knob covers are used to make the off limit areas inaccessible. All required forms were posted. LPA did not note any hazardous items accessible to children. There are is a properly fenced pool that meets department regulations. Licensee states that there are no weapons/firearms or ammunition in the home or on the property. The fire extinguisher size (2A10BC ) meets requirements and is fully charged. The smoke detector/carbon monoxide detectors meet department requirements. Applicant’s Pediatric CPR/FA is valid through 9/2024. Mandated reporter training was not completed due to language barrier. All adults living or working in the home have been fingerprint cleared and associated and immunization requirements have been met. Licensee and husband own the home. Outdoor play area is fully-fenced and equipped with age-appropriate play equipment and toys.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: HASHIMI, KHATERA FAMILY CHILD CARE
FACILITY NUMBER: 376101271
VISIT DATE: 10/26/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Applicant was reminded of requirements for children’s records, child abuse reporting, unusual incident reporting, immunizations, criminal background clearance procedures and policies, posting requirements, capacity limitations and Shaken Baby Syndrome. Smoking in or around day care areas is prohibited.

Applicant was reminded that all adults 18 and over living or working in the home, 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 $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Applicant is to be present in the home to ensure children are supervised and reminded that no children are to be left in parked vehicles and car seats are not to use used for sleeping. Capacity limitations were reviewed. LPA discussed California Megan's Law and the website was provided as follows: www.meganslaw.ca.gov

LPA discussed the safe sleep regulations with licensee Khatera Hashimi 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 licensee Khatera Hashimi 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 is reminded that infants may not be swaddled while in care and walkers, exersaucers, jumpers, bouncy seats, napping portables and drop sided cribs are not permitted for use.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: HASHIMI, KHATERA FAMILY CHILD CARE
FACILITY NUMBER: 376101271
VISIT DATE: 10/26/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
When any IMS is provided, an updated Plan of Operation that includes 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.

Licensee is signed up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov.

No deficiencies are cited. No corrections are needed; a license for 14 children will be issued effective today.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3