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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101522
Report Date: 06/22/2023
Date Signed: 06/22/2023 11:42:54 AM

Document Has Been Signed on 06/22/2023 11:42 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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:KOHISTANI, PARWIN FAMILY CHILD CAREFACILITY NUMBER:
376101522
ADMINISTRATOR:PARWIN KOHISTANIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 930-0126
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/22/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Parwin KohistaniTIME COMPLETED:
11:50 AM
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On June 22, 2023, at 9:05 AM, Licensing Program Analyst (LPA) Sherlynn Banas and Licensing Program Manager, Tashima Daniel conducted an announced Pre-Licensing inspection for the licensee"s change of location. Upon arrival, LPA met with licensee Parwin Kohistani and also present were Habib Ullah Kohistani (husband), adult children: Arzo Kohistani, Samim Kohistani, Hila Kohistani, and minor children: Sahil Kohistani and Mursal Kohistani (minor children/adults). The two story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home. The fireplace is screened, and the staircase is barricaded. There is a working phone at the facility. Applicant states that there are no weapons in the home. Licensee states that they have sufficient financial resources to sustain the license. CPR and First Aid expire in May 2025. Preventative health practices course was completed on April 7, 2019 which includes lead poison prevention training. No Mandated reporter training because applicant doesn’t speak English. She speaks Pashto. Staff immunization requirements were met. Required documents have been posted. Licensee owns the home. The licensee has toys and equipment available. Fire Clearance was granted on May 24, 2023.

Licensee will be using the following rooms for childcare in the first floor: 2 living rooms, dining room, kitchen, Room 1 by the kitchen with a bathroom. Off-limits areas include all of the second floor and the laundry room and are inaccessible through the use of a child safety lock. The garage will also be off limits and is kept inaccessible through the use of child safety lock. Backyard available for outdoor activities. Licensee understands that visual supervision is always practiced. A grant deed is on file.

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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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 NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: KOHISTANI, PARWIN FAMILY CHILD CARE
FACILITY NUMBER: 376101522
VISIT DATE: 06/22/2023
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LPA reviewed with licensee 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. The new provider packet was reviewed with the licensee including information on child abuse and unusual incident reporting. LPA provided information regarding the YMCA Resource center with a packet. Licensee was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used only as intended by the manufacturer. LPA and licensee discussed Shaken Baby Syndrome and California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA, Sherlynn Banas reviewed COVID-19 guidelines with Applicant and provided COVID-19 resources.

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 and 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.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: KOHISTANI, PARWIN FAMILY CHILD CARE
FACILITY NUMBER: 376101522
VISIT DATE: 06/22/2023
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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 following corrections are needed prior to the issuance of the license:
There should be a gate installed by the backyard where there are new improvements being done towards the gate, three sides of patio table edge needs to be protected as they have sharp edge, and the 2 crib mattresses need appropriate fitted sheets.

Once all corrections are made and proof is sent to licensing, license for 14 children may be granted. Licensee understands that proof of corrections must be submitted to Licensing within 30 days or the application may be denied. Applicant agreed to comply with all regulations and laws governing family child-care homes.

Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for forms and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.



Exit interview conducted and report was reviewed with the licensee, Parwin Kohistani and spouse, Habib Ullah Kohistani, and adult daughter, Hila Kohistani who provided translation.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
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