376101526-7-20-2023-51-CC-PMAA-CTWPSZ-20230720113511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376101526
Report Date: 07/20/2023
Date Signed: 07/20/2023 11:35:21 AM

Document Has Been Signed on 07/20/2023 11:35 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:	KOHISTANI, MUHAMMAD ZAMAN FAMILY CHILD CARE		FACILITY NUMBER:	376101526
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 2	CENSUS: 2	DATE:	07/20/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Muhammad Zaman Kohistani		TIME COMPLETED:	11:50 AM

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 7/20/23 at 9:15am, Licensing Program Analyst (LPA) Patrick Ma conducted an announced Change of Location Pre-Licensing inspection with the applicant Muhammad Kohistani. Also present in the home were Licensee's son, Zakirullah Kohistani, and his wife Lima Kohistani. There were also 2 children present from one family they were providing care to. Son helped translate during the inspection. The 4 bedroom, 3 bathroom, 2 story home was toured and inspected to ensure an environment safe for the care and supervision of children. During inspection, Lima Kohistani was the primary adult providing care to the children present. Mrs. Kohistani did not have a completed helper file at the facility. Infant in care did not have Infant Sleep or sleep log despite applicant only changing locations and was previously licensed. Playpen present for infant under 12 months had a loose fitting sheet with a play arch, both a violations of Title 22, Section 102425. Both were corrected during the inspection and regulation was provided to applicant. Applicant will be using the living room, dining room, kitchen, downstairs bathroom, and back/side yard for child care. Off limit areas are garage and entire upstairs and are inaccessible by use of child safety gate at the bottom of the stairs and doorknob cover for the garage. The applicant has sufficient toys and equipment available. Applicant will use fully fenced back/side yard for outdoor activities. Licensee was advised to provide visual supervision at all times when children are outdoors. 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. Facility has a decorative fireplace that applicant states does not get hot to touch.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: KOHISTANI, MUHAMMAD ZAMAN FAMILY CHILD CARE	FACILITY NUMBER: 376101526
	VISIT DATE: 07/20/2023

NARRATIVE

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There are no bodies of water on the property. Applicant states that there are no weapons in the home. Applicant states that they have sufficient financial resources to sustain the license. 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. First Aid and CPR expire on 11/2024 and preventative health practices course was completed on 11/9/22. Applicant completed Mandated Reporter Training and expires on 12/4/24. Staff immunization requirements per SB792 were met.

The applicant provided proof of control of property. Because the applicant rents the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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. Entrance Checklist was provided to the applicant.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

On this date, 7/20/23, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore,
they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: KOHISTANI, MUHAMMAD ZAMAN FAMILY CHILD CARE	FACILITY NUMBER: 376101526
	VISIT DATE: 07/20/2023

NARRATIVE

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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, 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.

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-andresources/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.

LPA discussed and provided applicant with the following information:
• Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov.
• For common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.
• To report COVID-19 cases contact the Health & Human Services Agency Epidemiology Department at 619-692-8636.

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) or (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.
Applicant was informed of the MyChildCarePlan.org site, 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.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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: KOHISTANI, MUHAMMAD ZAMAN FAMILY CHILD CARE	FACILITY NUMBER: 376101526
	VISIT DATE: 07/20/2023

NARRATIVE

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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 platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Applicant was reminded that if he is licensed annual fees are due on the date they were licensee every year. Licensee is reminded that the license is NOT transferable and should he relocate, without proper notice, this license will be null and void.

The following corrections are needed:
• Helper documents for Lima Kohistani (LIC 9108, 9058, Mandated Reporter training Certificate)
• Infant Sleep plan and log for infant present at inspection

Applicant understands that corrections must be submitted to the Department within 30 days or the application may be denied.

LPA reminded applicant, California Code of Regulations Title 22, Section 102417(a) Operation of a Family Child Care Home state:

The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

Exit interview conducted and report was reviewed with the applicant Muhammad Kohistani.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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