376102351-1-7-2025-51-CC-GPOR-DCPQAG-20250107105956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376102351
Report Date: 01/07/2025
Date Signed: 01/07/2025 11:00:11 AM

Document Has Been Signed on 01/07/2025 11:00 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:	NURISTANI, AMENA FAMILY CHILD CARE		FACILITY NUMBER:	376102351
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	01/07/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Amena Nuristani		TIME VISIT/ INSPECTION COMPLETED:	11:30 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 1/7/25, Licensing Program Analyst (LPA) Gerald Poindexter identified himself and disclosed the nature of the visit before being granted entry. LPA Poindexter then conducted an announced pre-licensing inspection. LPA met with applicant, Amena Nuristani. Also, present (and providing translation from English to Nuristani) was the applicant’s husband, Nawab Nuristani Melabhar. The 3-bedroom, 2-bath one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Applicant owns the home. Verification of control of property is on file. Applicant states that they have sufficient financial resources to sustain the license. Applicant will use the following rooms for childcare: Living Room, Kitchen, Sun Room, Bedrooms 1 and 2, Bathroom 1, and the Backyard. Bedroom 1 and 2 will be used to care for/separate sick children. Off-limits areas include: Bedroom 3 (Master bed and master bath) and the garage (outside entry only). These areas prevent access through use of door locks. There are no stairs in the home. Applicant has a fully fenced backyard available for outdoor activities. No hazardous items were witnessed in the backyard. Applicant is advised to provide direct supervision when outside. Applicant states they will also take the children to a nearby park for outdoor activities and understands that continuous visual supervision is required. There are no bodies of water in the home. There is a working phone at the facility. The fire extinguisher meets 2A10BC requirements. Carbon monoxide detector and smoke detector were tested and are operational. Poisons, cleaning compounds, medications and other hazardous items were latched/locked and secured out of reach of children. Heating and ventilation equipment were reviewed. Central heat/air vents are located high toward the ceiling. The living room fireplace is screened and latched. Applicant states there are NO firearms or ammunition in the home. The applicant has age-appropriate toys and equipment available. CONTINUED ON PAGE 2

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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: NURISTANI, AMENA FAMILY CHILD CARE	FACILITY NUMBER: 376102351
	VISIT DATE: 01/07/2025

NARRATIVE

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Pediatric CPR and First Aid expire 2/3/26. Preventative health practices course (with lead poison prevention training) completed 12/18/24. Mandated reporter training completed 11/27/24, expires 11/27/26. Applicant’s primary language is Nuristani (also speaks Pashto and Farsi). Staff /resident immunization requirements were met. All required health/safety and facility-related documents were visibly posted.

Applicant 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.

LPA reviewed the following resources and information with applicant:
· LIC 311D, Forms/Records to Keep in Your Family Child Care Home, children’s forms/records, facility forms/records, and information required to be posted
· New provider packet, including unusual incident reporting procedures
· Rules related to children’s personal rights, child abuse, and prohibiting of corporal punishment
· Rules prohibiting smoking, walkers, exersaucers, jumpers and bouncy seats. Also, allowed/prohibited uses of car seats.
· Use of all equipment only as intended by the manufacturer
· Shaken Baby Syndrome and SIDS
· California Megan's Law and website: www.meganslaw.ca.gov
· COVID-19 and other communicable diseases guidelines and resources
· Provider Information Notices (PINs), Program Quarterly Update Newsletters, and the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe.
· YMCA Resource Center information
· Additional CDSS contact information and provider resources

LPA discussed the safe sleep regulations with the 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
CONTINUED ON PAGE 3

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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: NURISTANI, AMENA FAMILY CHILD CARE	FACILITY NUMBER: 376102351
	VISIT DATE: 01/07/2025

NARRATIVE

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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.

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 correction is needed prior to the issuance of the license:

· Install lever lock for master bedroom door

Once all corrections are made and proof is sent to, reviewed, and approved by the Department, a license for eight children may be granted upon the final file review. Applicant understands that proof of corrections must be submitted to Licensing within 30 days, by no later than 2/6/25, or the application may be denied. Applicant agreed to comply with all regulations and laws governing family child-care homes.

Exit interview conducted and report was reviewed with the applicant Amena Nuristani. Appeal rights provided.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

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