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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101489
Report Date: 06/13/2023
Date Signed: 06/13/2023 10:42:37 AM

Document Has Been Signed on 06/13/2023 10:42 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MOJADDIDI, ARZU FAMILY CHILD CAREFACILITY NUMBER:
376101489
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Arzu MojaddidiTIME COMPLETED:
10:50 AM
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On 6/13/23 at 8:40 a.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an announced pre-licensing/change of location inspection with applicant, Arzu Mojaddidi. Also present was the applicant's minor sister who translated for the applicant as needed. The applicant's primary language is Dari. The purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3. This 3 bedroom, 2 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children.

Applicant rents the facility and has provided proof by rental agreement. Applicant has provided LPA Curtis with a completed copy of the LIC9149, Landlord Consent allowing Applicant to operate at the full capacity of 8 children. Applicant will use the following areas for child care: living room/dining area, kitchen, downstairs bedroom, downstairs bathroom and enclosed rear yard. Off limits areas include: entire second floor. Stairs are barricaded via a safety gate. Applicant will utilize enclosed rear yard for outdoor activities. There are no bodies of water observed during time of visit. The applicant states that the townhouse community has a swimming pool which is fenced and locked. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. All poisons, cleaners and hazardous items in the home are inaccessible to children through latches, locks, and/or placed up on high surfaces.

Children’s toys and play equipment are available. Applicant states there are NO firearms or other weapons in the home. Applicant has completed the 8 hours of preventative health training. Pediatric CPR and First Aid certifications expire on 3/13/24. Applicant has completed the Mandated Child Abuse Reporting-per AB1207. LPA reviewed certification and it is in compliance. Required documents are posted. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Immunization records per SB792 were reviewed and are in compliance for all personnel that will be providing care and supervision to children. Applicant is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MOJADDIDI, ARZU FAMILY CHILD CARE
FACILITY NUMBER: 376101489
VISIT DATE: 06/13/2023
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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.

The maximum capacity for a small family child care home: 4 infants only (infants mean any 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 age 10 who live in the licensee's home.

The New Provider Resource Packet was reviewed with the applicant including information on the following: SIDS, shaken baby syndrome, effects of lead, insurance, child abuse reporting, community resources, immunization's, car seat law, visual for ratio/capacity, prohibited items handout (walkers, exersaucers, jumpers and bouncy seats), fire/disaster drill log, safe sleep log, and the YMCA Resource Center. The applicant was also reminded that corporal punishment and smoking are not allowed in the day care. LPA discussed California Megan's Law and provided: www.meganslaw.ca.gov.

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.

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 $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Any minor upon his/her 18th birthday must be fingerprinted within 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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: MOJADDIDI, ARZU FAMILY CHILD CARE
FACILITY NUMBER: 376101489
VISIT DATE: 06/13/2023
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LPA discussed the safe sleep regulations with 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 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 the CPSC to be notified of any recalls on their purchased equipment.

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.

A Regular Small Family Child Care Home License may be issued upon final file review. Applicant states that she will comply with all regulations and laws governing family child care homes and that she is financially secure to operate a family child care home for children.

Exit interview conducted and report was reviewed with the applicant, Arzu Mojaddidi.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
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