376101536-7-15-2024-51-CC-RROZ-D77QZJ-20240715123651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376101536
Report Date: 07/15/2024
Date Signed: 07/15/2024 12:37:56 PM

Document Has Been Signed on 07/15/2024 12:37 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	NOORISTANI, ADINA & ZIA FAMILY CHILD CARE		FACILITY NUMBER:	376101536
ADMINISTRATOR/ DIRECTOR:	ADINA & ZIA NOORISTANI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 396-8457
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 41	CENSUS: 5	DATE:	07/15/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:55 AM
MET WITH:	Adina Nooristani		TIME VISIT/ INSPECTION COMPLETED:	12:40 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 7/15/24 at 10:55 a.m., Licensing Program Analyst (LPA), Renita Rodriguez , conducted an unannounced annual inspection. LPA was greeted at the front door by licensee Adina Nooristani. Also present in the home was helper Parwin Sharafat. LPA was granted entry after showing badge and identifying herself and disclosing the purpose of her visit. The 4 bedroom and 2 bathroom home was toured and inspected for compliance. The children are provided a safe, healthful, and comfortable environment, furnishings, and equipment. Licensee was provided the Inspection Checklist (LIC 126). The one story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present in the home were 5 day care children (two infants). Areas used for child care include living room, dining room, kitchen, bedroom 2, bathroom 2, and backyard. Off limits areas include bedroom 1, bedroom 3, master bedroom, master bathroom and garage. The licensee has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. Licensee understands that visual supervision is required at all times during outdoor activities. The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There is a fireplace located in the living room which is locked and secured. There is no body of water on the property. Licensee states there are no firearms and LPA did not observe any. First Aid and CPR certifications expire on 8/25/24 . Licensee has required immunizations. Licensee completed Mandated Reporter Training on 4/24/23 and is reminded it must be completed every 2 years. Children’s and Staff records were reviewed.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Renita Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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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Document Has Been Signed on 07/15/2024 12:37 PM - It Cannot Be Edited

Created By: Renita Rodriguez On 07/15/2024 at 11:34 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: NOORISTANI, ADINA & ZIA FAMILY CHILD CARE	FACILITY NUMBER: 376101536
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above. Licensee did not have in file the immunizations for 3 children enrolled which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/23/2024
	Plan of Correction
1 2 3 4	Licensee will obtain the records and send to LPA Renita Rodriguez by email at renita.rodriguez@dss.ca.gov

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above Licensee did not obtain the form for 3 children enrolled, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/23/2024
	Plan of Correction
1 2 3 4	Licensee will obtain the documentation and send to LPA Renita Rodriguez at renita.rodriguez@dss.ca.gov.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Renesha Askew

LICENSING EVALUATOR NAME:

Renita Rodriguez

LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

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: NOORISTANI, ADINA & ZIA FAMILY CHILD CARE	FACILITY NUMBER: 376101536
	VISIT DATE: 07/15/2024

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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 licensee [or facility representative] 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 was reminded that all adults 18 and over living or working in the home, 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; 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.

See LIC 809D for citations issued.

Exit interview conducted and report was reviewed with the licensee Adina Nooristani.

During the exit interview, the Licensee Adina Nooristani confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 day

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Renita Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

LIC809 (FAS) - (06/04)

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