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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376102854
Report Date: 04/20/2026
Date Signed: 04/20/2026 05:59:58 PM

Document Has Been Signed on 04/20/2026 05:59 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:AHMADI, SHAKIBA FAMILY CHILD CAREFACILITY NUMBER:
376102854
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 13CENSUS: 8DATE:
04/20/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Shakiba AhmadiTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
NARRATIVE
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On 4/20/26 at 1:30 pm, Licensing Program Analyst (LPA) Gerald Poindexter conducted an case management visit for an increase in capacity. Upon arrival, LPA met with the licensee, Shakiba Ahmadi. There were six daycare children present during the inspection and two of the licensee’s own minor children. The licensee’s husband, Islamuddin Ahmadi, arrived at the home at approximately 2:40 pm and provided Dari translation, as needed. The licensee applied to the Department and a fire clearance report was provided to the Department on 11/3/25. Ms. Ahmadi states hours of operation are from 7 am to 10 pm, Monday through Friday. Licensee’s preferred language is Dari. The 2-bedroom, 2-bath, two-story home was toured and inspected to ensure an environment safe for the care and supervision of children. The applicant has provided proof of control of property. Because the licensee rents/leases the home, proof of landlord notification is required. The LPA has observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149).

Areas used for childcare include: living room, kitchen, bathroom #1, and backyard patio. Off limits areas include the garage and the entire second floor. Off limit areas are inaccessible through use of safety gates at the bases of the stairwell. LPA also observed safety latches on kitchen drawers and a level lock on the kitchen pantry door. There is no garage. Licensee states that she uses the nearby park at the local library (directly across the street) for outdoor activities. Licensee also requested to allow daycare children to use the small cobblestone patio area in the back of the home. LPA inspected the area. Because the back patio area is located near automobile parking, the licensee agrees they will always escort children to and from the patio area. Licensee was reminded that direct, visual supervision is required when outdoors. The facility has sufficient toys and equipment available. The licensee’s home was not observed to contain a body of water...CONTINUED ON PAGE 2
NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Gerald Poindexter
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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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: AHMADI, SHAKIBA FAMILY CHILD CARE
FACILITY NUMBER: 376102854
VISIT DATE: 04/20/2026
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was reminded that direct, visual supervision is required when outdoors. The facility has sufficient toys and equipment available. The licensee’s home was not observed to contain a body of water.

There is a fully charged fire extinguisher, smoke and carbon monoxide detector that meet requirements and are operational. There is fireplace. Poisons, cleaning compounds, medications and other hazardous items are inaccessible to children via latches, locks and high placement. Adequate heating and ventilation are provided and vents are located near at ceiling level. There is a working telephone and email address. Licensee stated there are NO firearms and weapons in the home.



LPA observed all required postings were posted. Children’s records were reviewed and found to be incomplete. Staff records were reviewed and found to be complete. Licensee has the required immunizations per SB792. Licensee’s pediatric CPR/First Aid cards are current with expiration date of 8/26/27. Preventative health practices course was completed, which includes lead poison prevention training. Licensee’s Mandated Reporter Training certificate per AB1207 expires 8/27/27. LPA reminded licensee that Mandated Reporter Training and Pediatric CPR/First Aid training must be renewed every 2 years. LPA reviewed helper requirements and capacity limitations with the licensee, as well as provided form LIC9150 PARENT NOTIFICATION ADDITIONAL CHILDREN IN CARE.

Emergency drills were not conducted and documented. LPA reminded licensee that emergency drills must be conducted and documented every six months. Licensee did not maintain a current roster of the children which LPA obtained during time of inspection. LPA verified that all adults living or working in the home have been fingerprint cleared and associated. LPA reminded Licensee that all unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203. Duty officer number is (619) 767-2248.

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.

CONTINUED ON PAGE 3

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Gerald Poindexter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
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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: AHMADI, SHAKIBA FAMILY CHILD CARE
FACILITY NUMBER: 376102854
VISIT DATE: 04/20/2026
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LPA conducted child care quality management staff interview with the licensee. 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 the licensee of the importance of checking for recalled infant

The licensee 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.

On this date, 4/20/26 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. California Megan's Law and website: www.meganslaw.ca.gov

The licensee 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. 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-and-resources/safe-sleep, as an additional resource. LPA also informed licensee 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 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) https://www.ada.gov/resources/child-care-centers/. CONTINUED ON PAGE 4
NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Gerald Poindexter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
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: AHMADI, SHAKIBA FAMILY CHILD CARE
FACILITY NUMBER: 376102854
VISIT DATE: 04/20/2026
NARRATIVE
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514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:

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-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed prior to the issuance of the license:

· Signed Property Owner/Landlord Consent form (LIC9149)


· Signed LIC9150 PARENT NOTIFICATION ADDITIONAL CHILDREN IN CARE
· Signed LIC627 CONSENT FOR MEDICAL TREATMENT
· Completed LIC9040 FACILTY ROSTER
· Updated Emergency Drills Log
· Update Safe Sleep Logs for infants in care
· Provide documents verifying child’s enrollment in kindergarten or TK

Once all corrections are made and proof is sent to, reviewed and approved by the Department, a license for 14 children may be granted upon the final file review. Applicant understands that proof of corrections must be submitted to by the POC due dates or the application may be denied. Exit interview conducted and report was reviewed with the licensee, Shakiba Ahmadi. A Notice of Site Visit was provided and must remain posted for 30 days. Appeal Rights provided.

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Gerald Poindexter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 04/20/2026 05:59 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 04/20/2026 at 04:17 PM
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: AHMADI, SHAKIBA FAMILY CHILD CARE
FACILITY NUMBER: 376102854

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2026
Section Cited
CCR
102421(d)(1)

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(d) In any case in which the licensee cares for an additional child…(1) The licensee shall maintain a completed and signed LIC 9150 (Rev. 8/14) Parental Notification Additional Children in Care... This requirement is not met as evidenced by:
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Licensee stated that they will provide the completed and signed LIC9150 by the POC due date. Email to Gerald.Poindexter@dss.ca.gov.
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Based on interview and record review, the licensee did not have completed and signed LIC9150 forms for 6 of 6 children in care, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
05/04/2026
Section Cited
CCR102421(d)

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(c) In any case in which the licensee cares for an additional child…the licensee shall maintain, in the child's record, a copy of documentation verifying the child's enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school ... This requirement is not met as evidenced by:
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Licensee stated that they will provide the required documentation by the POC due date. Email to Gerald.Poindexter@dss.ca.gov.
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Based on interview and record review, the licensee did not have completed and signed LIC9150 forms for 3 of 6 children in care, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Gerald Poindexter
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/20/2026 05:59 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 04/20/2026 at 04:39 PM
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: AHMADI, SHAKIBA FAMILY CHILD CARE
FACILITY NUMBER: 376102854

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2026
Section Cited
CCR
102417(g)(9)(A)(1)

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Operation of a Family Child Care Home: (g) The home shall be free from defects… or conditions which might endanger a child…. (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department….(A)Each family child care home shall conduct fire drills and disaster drills at least once every six months. (1)The licensee shall document the drills, including the date and time of each drill. This requirement is not met as evidenced by:
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LPA provided a sample copy of emergency drill log to the licensee, who stated they will conduct a fire drill or earthquake drill by the POC due date. The licensee will email a photo of the documentation to LPA via email by POC date. Email: Gerald.Poindexter@dss.ca.gov
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Based on interview and review of facility records, licensee has not performed or documented a fire drill every 6 months as required, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
05/04/2026
Section Cited
CCR102417(g)(8)

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102417(g)(8), Children’s Roster: (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
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Licensee states she will create and submit a complete roster of enrolled children to the Department by the POC .due date. Email to Gerald.Poindexter@dss.ca.gov.
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Based on record review and interview, the licensee did not comply with the section cited above, as the current roster of children was not updated with current children in care, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Gerald Poindexter
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/20/2026 05:59 PM - It Cannot Be Edited


Created By: Gerald Poindexter On 04/20/2026 at 04:48 PM
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: AHMADI, SHAKIBA FAMILY CHILD CARE
FACILITY NUMBER: 376102854

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2026
Section Cited
CCR
102417(g)(7)

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Operation of A Family Child Care Home: (7) An emergency information card shall be maintained for each child and shall include… the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
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Licensee says she will obtained all required signed and dated LIC627 forms from parents for each enrolled child by the POC due date. Email to Gerald.Poindexter@dss.ca.gov.
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Based on record review, the licensee did not comply with the section cited above, as of 3 of 6 children present did not have signed LIC627 forms. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
05/04/2026
Section Cited
CCR102425(j)(2)(D)

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102425(j)(2)(D), Safe Sleep Log: ...documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include.... a. Date. b. Infant’s name. c. Time of each 15-minute check. This requirement is not met as evidenced by:
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LPA reviewed the requirement of the Safe Sleep Log with the licensee, who stated she will begin maintaining the log immediately. Licensee will submit the sleep documentation to LPA by POC due date and keep updated in the future. Email to Gerald.Poindexter@dss.ca.gov.
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Based on interview and record review, the licensee did not comply with the section cited above, as she did not possess and maintain the safe sleep logs for 2 of 2 infants in care, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Gerald Poindexter
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2026


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