376101580-10-26-2023-51-CC-SBAS-CWXPUZ-20231025113821

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376101580
Report Date: 10/25/2023
Date Signed: 10/26/2023 08:20:40 AM

Document Has Been Signed on 10/26/2023 08:20 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:	KHAWARY, ZAHRA FAMILY CHILD CARE		FACILITY NUMBER:	376101580
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/25/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Zahra Khawary		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 October 25, 2023, at 9:30 AM, Licensing Program Analyst (LPA) Sherlynn Banas conducted an announced Pre-Licensing/ Change of Location inspection for Zahra Khawary (Applicant). Upon arrival, LPA met with Applicant and son, Mehren Khawary who translated for the applicant. The two story house was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher (located in the kitchen), 1 carbon monoxide detector (located in the kitchen), and the combo smoke detector and carbon monoxide (located in the hallway by the living room) meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There is a working phone at the facility. There are no bodies of water in the home. Applicant states that there are no weapons in the home. Applicant states that they have sufficient financial resources to sustain the license. CPR and First Aid expires on September 2, 2025. Preventative Health practices course was completed on April 10, 2019, which includes lead poison prevention training. The applicant doesn’t have the Mandated reporter training because applicant speaks Dari. Immunization requirements were met. Required documents have been posted. Applicant owns the home. The applicant has old toys and will be replaced by new ones. Applicant will be using the following rooms for childcare: Living room, kitchen, dining room, bathroom 1, and bedroom 1, are used as accessible for day care. Off-limits areas include the garage, all the second-floor rooms, and backyard are inaccessible using barricade for the stairs and a stopper for the sliding room going to the backyard. LPA asked if there is a separate room or place for isolation when one child/ children were sick, and applicant stated that bedroom 1 will be used. Applicant stated that she will take the children to the community park which is walking distance from their home. Applicant understands that visual supervision is always required. Verification of control of property is on file. Property owner/Landlord notification is on file. Landlord consent is on file.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

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: KHAWARY, ZAHRA FAMILY CHILD CARE	FACILITY NUMBER: 376101580
	VISIT DATE: 10/25/2023

NARRATIVE

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Mrs. Zahra Khawary understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care for 8 [or 14] children.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to clearance or exemption, shall 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.

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. The new provider packet was reviewed with the applicant including information on child abuse and unusual incident reporting. LPA provided information regarding the YMCA Resource center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and applicant discussed Shaken Baby Syndrome and California Megan's Law. LPA provided: www.meganslaw.ca.gov.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep information which can be found 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.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

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: KHAWARY, ZAHRA FAMILY CHILD CARE	FACILITY NUMBER: 376101580
	VISIT DATE: 10/25/2023

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 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.

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 applicant needs to obtain the following for the facility:

1. 8 Stopper for the windows.
2. New toys for the children.

A license for 8 children may be granted upon final file review. Applicant agreed to comply with all regulations and laws governing family child-care homes.

Exit interview conducted and report was reviewed with the applicant Zahra Khawary with translator and Appeal Rights was provided.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023

LIC809 (FAS) - (06/04)

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