376301226-12-5-2024-10-CC-KGEH-DBNP8L-20241205100543

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376301226
Report Date: 12/05/2024
Date Signed: 12/05/2024 10:05:56 AM

Document Has Been Signed on 12/05/2024 10:05 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	HASHEMI FAMILY CHILD CARE		FACILITY NUMBER:	376301226
ADMINISTRATOR/ DIRECTOR:	HASHEMI,SAQILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 428-4011
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	12/05/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:31 AM
MET WITH:	Shaqila Hashemi		TIME VISIT/ INSPECTION COMPLETED:	10:32 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 date and listed above, Licensing Program Analyst (LPA) Kelly Gerth arrived at the facility to conduct a pre-licensing inspection. Present during this inspection were: Shaqila, Amir, Mosamed and Vahid Hashemi. The home has 4 bedrooms, 3 bathrooms, with attached garage and upper balcony. LPA toured the facility, inside and out with Shaqila and Amir Hashemi and the following was observed and/or discussed: · Per Applicant, off-limit areas include: Garage, Outdoor Barbecue Nook, Second floor · On-limit areas include Backyard, Kitchen, Living and Dining room, downstairs bedroom, bathroom and front yard. · Normal hours of operation will be: Monday-Sunday, 23 hrs and 59 min · Smoke detectors and Carbon Monoxide detectors were tested by the applicant during this inspection and were in working order. · There is central heating and air conditioning. · The fire extinguisher is fully charged/meets standards established by State Fire Marshal. · All hazardous items were observed to be inaccessible. Storage of poisons and toxins are inaccessible to children and locked in the kitchen pantry. Sharp items including kitchen knives, are inaccessible and stored in kitchen pantry Medicines are locked and stored in kitchen pantry, which has a child safety lock. · First Aid Kit is located in the downstairs bathroom. · No guns or weapons are stored in the facility as of this date. Applicant understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. · Stairs are not currently barricaded, however applicant has ordered a gate for the stairs. · The fireplace is properly screened See Next Page

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: HASHEMI FAMILY CHILD CARE	FACILITY NUMBER: 376301226
	VISIT DATE: 12/05/2024

NARRATIVE

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· Clean, safe and age-appropriate toys were observed.
· LPA observed a working telephone
· There were no toxic plants inside or outside the facility observed at this time, however there are rose bushes near the front play area that are to be trimmed back and made inaccessible to children before licensing.
· The outside activity area consists of: the backyard with exception of an off limits Barbeque Nook and the front yard.
· There are no bodies of water observed on this date. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and spas, and some fountains must be properly covered or fenced per title 22 regulations. The Department must be notified before and after installation of the bodies of water described. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Applicant will be transporting children. Applicant will be using a 2022 Model Y Tesla to pick-up and drop-off children. The vehicle is in safe operating condition.
· Verification of control of property is maintained by applicant
· Facility Sketch and Emergency Disaster Plan will be posted inside the front entrance hallway, on a mounted bulletin board.
· Pediatric CPR and First Aid Card expires September 02, 2025.
· Mandated Reporter certificate expires December 14, 2026.
· Preventive Health and Safety training, including nutrition and lead components class is scheduled for December 08, 2024.
Applicant Shaqila Hashemi was reminded all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 Child Care Center. 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.

See Next Page

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: HASHEMI FAMILY CHILD CARE	FACILITY NUMBER: 376301226
	VISIT DATE: 12/05/2024

NARRATIVE

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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) or (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

LPA reviewed with Applicant Shaqila Hashemi the LIC 311A, Forms/Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
LPA discussed the safe sleep regulations with Applicant Shaqila Hashemi 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 Applicant Shaqila Hashemi 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.
On this date, December 05, 2024 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 address. 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.
Applicant Shaqila Hashemi 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.
See Next Page

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: HASHEMI FAMILY CHILD CARE	FACILITY NUMBER: 376301226
	VISIT DATE: 12/05/2024

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.
The following items were also reviewed with the applicant during inspection:
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter and updating training every 2 years
- Personal rights of children in care, including no corporal punishment
- Responsibility to know the Title 22 Regulations for anyone providing care/ supervision
- Capacity and Supervision requirements
- Inaccessibility of hazards must be constantly reassessed depending on children in care
- Current facility phone numbers must always be on file with the licensing office
- Baby walkers, bouncy seats, exer-saucers, and other similar items are prohibited
- Car seat law
- Smoking is prohibited in the facility while providing child care or transporting children
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
-The Applicant can submit fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov
See Next Page

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: HASHEMI FAMILY CHILD CARE	FACILITY NUMBER: 376301226
	VISIT DATE: 12/05/2024

NARRATIVE

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- Access to forms & Title 22 Regulations for Family Child Care Homes online at www.ccld.ca.gov

- The Duty Officer is available to answer questions Monday – Friday 8:00am to 5:00pm at: 951-782-4200.

Before licensure, the following needs to be corrected/completed:
1. Front Yard Rose Bushes Trim back and/or make inaccessible
2. Gate at bottom of stairs
3. Child proof lock on downstairs on limits bathroom sink cabinets and drawers
4. Post all documents necessary for Parent Board/Entrance Board.
5. Gate/Make BBQ Inaccessible

Once all corrections have been verified, the application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12 or 14 with parent notification. Applicant advised that all corrections are due within 30 days, or the application may be withdrawn.

Exit interview conducted and report was reviewed with the Applicant Shaqila Hashemi.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024

LIC809 (FAS) - (06/04)

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