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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101939
Report Date: 05/07/2024
Date Signed: 05/07/2024 11:21:15 AM

Document Has Been Signed on 05/07/2024 11:21 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 N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GOSHTASB, NEGIN FAMILY CHILD CAREFACILITY NUMBER:
376101939
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
05/07/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Negin GoshtasbTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 5/7/24 at 10:40 am LPA Annette Sutherland conducted an unannounced pre-licensing site visit for a capacity increase; this visit is to verify that the licensee remains in substantial compliance with the health & safety standards as required by regulations governing family childcare homes. LPA met with licensee Negin Goshtasb. Licensee has all appropriate forms posted. LPA confirmed with licensee that all adults residing/working in the home have criminal record/TB clearances. Applicant owns the home.The home appears to be large enough to comfortably accommodate 14 children. Fire clearance was received on 5/1/24. First Aid and CPR certifications expire on 1/21/25. Licensee has practiced fire/emergency drills with daycare children according to regulations.

The 3-bedroom, 2-bathroom, one level home was toured and inspected to ensure an environment safe for the care and supervision of children. License has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include the following areas: living room, bathroom #1, bedroom #2 and backyard. Off limit areas include Kitchen, family room, master bedroom, bathroom, bedroom #1 and garage. Off-limit areas have been made inaccessible with the use of doorknob covers and safety gates.

Drawers and lower cabinets in kitchen/bathroom are either latched or do not contain any hazardous items. There is an operational smoke alarm, carbon monoxide detector and fire extinguisher maintained in the home. There are adequate age-appropriate toys, books, games, and napping mats/hygienic diaper changing equipment. There are no firearms present on the premises as stated by licensee. Furthermore, there are no bodies of water. The outdoor play area is a fenced backyard, which is free of hazards and has sufficient toys. Per licensee, operating hours are from 7:30 am - 5:00 pm, Monday thru Thursday & 7:30 – 4:30pm on Fridays.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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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: GOSHTASB, NEGIN FAMILY CHILD CARE
FACILITY NUMBER: 376101939
VISIT DATE: 05/07/2024
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LPA reviewed the following: required departmental documents, regulation highlights, community resources, capacity limitations, supervision, clearances, emergency drills, heat-related illness, child passenger law, unusual incidents, mandated reporting, Assembly Bill 633, SIDS, Safe sleep regulations, Shaken Baby Syndrome, Megan's law and Covid information. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation.
For licensing regulations/updates/forms, go to webpage http://www.ccld.ca.gov

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.


No deficiencies are cited. No corrections are needed; a license for 14 will be issued effective today.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this report LIC 809 acknowledges receipt of these rights. LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC809 (FAS) - (06/04)
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