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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101460
Report Date: 07/03/2023
Date Signed: 07/03/2023 11:38:40 AM

Document Has Been Signed on 07/03/2023 11:38 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:AFZALI, ASIEH & SAFIOLLAH FCCFACILITY NUMBER:
376101460
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 1DATE:
07/03/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Asieh Afzali and Safiollah AfzaliTIME COMPLETED:
10:45 AM
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On 07/03/2023 at 9:30am, Licensing Program Analyst (LPA) Selina Siao conducted an Pre-Licensing change of location inspection with both applicants Asieh Afzali and her husband Safiollah Afzali and their primary language is Farsi. The 4 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, smoke and carbon monoxide detector that are operational. All hazardous items were latched/locked and secured out of reach of children. 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 06/07/2025 and both applicants completed the 8 hours preventative health practice course on 06/06/2023. A review of staff records on this date indicates that both applicant and their son Mohammad Arash Afzali are the current adults that lives at the home has the required background clearances and TB clearances. Both applicant's has the required measles and pertussis immunization. Applicants owns the property and has submitted a copy of their grant deed to show that they have control of the property.

Applicant will be using the following areas for childcare: living room, dining area, kitchen and 1/2 bath located downstairs. Off limit areas includes the garage and all of upstairs and there is a door knob cover to prevent children's access to the garage and a gate at the bottom of the stairs to prevent children's access. The home has some toys and equipment available for children. There is a fenced backyard available for children to play.
LPA reviewed the facility's children's records, unusual incident reporting and provided them with the effects of lead exposure form to provide to parents. LPA also provided the safe sleep regulation, individual safe sleep plan, infant sleep log and the latest LIC311D (Children's records form) with applicants.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2023
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: AFZALI, ASIEH & SAFIOLLAH FCC
FACILITY NUMBER: 376101460
VISIT DATE: 07/03/2023
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Applicants 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.

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

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

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

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at www.ccld.ca.gov.

During today's inspection, an updated application was received to have Asieh Afzali as the licensee as they would like to apply for a large license right after they are granted with a small license.

The following corrections are needed prior to granting a license:
  • Put a gate at the yard to prevent children's access to the storage area
  • Remove or make the two rose plants in the backyard inaccessible to children
  • Put a safety latch under the 1/2 bath sink cabinet in the restroom

Applicants shall submit the above corrections to LPA via email or text within a week no later than 7/10/2023. LPA called language link by having interpreter ID# 16159 to assist with translation in Farsi of the report during today's inspection.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
LIC809 (FAS) - (06/04)
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