376629427-9-13-2022-20-CC-ECAA-CJ8Q2R-20220913114735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629427
Report Date: 09/13/2022
Date Signed: 09/13/2022 11:47:58 AM

Document Has Been Signed on 09/13/2022 11:47 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	HAMIDI, SAMIRA FAMILY CHILD CARE		FACILITY NUMBER:	376629427
ADMINISTRATOR:	SAMIRA HAMIDI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 990-5086
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91915
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/13/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Samira Hamidi		TIME COMPLETED:	12:00 PM

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	Licensing Program Analyst (LPA) Edgar Campana conducted an announced prelicensing inspection with applicant, Samira Hamidi. The applicant's spouse, Ahmad Hamidi, assisted with translating by telephone. Purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This two story, three bedroom, three bath house was toured and inspected. Applicant will use the following areas for child care: living room, dining room, downstairs bathroom, kitchen, upstairs bedrooms 1 & 2, upstairs bathroom and back yard. Off limits areas include: master bedroom (bedroom 3), master bathroom, laundry room and garage. They are made inaccessible to day care children through the use of door locks. Applicant will utilize the back yard for outdoor activities, it is properly fenced. The upstairs will be used and applicant has stated that the stairs will be gated off at the bottom and top of the stairway. Applicant understands the gates must be in place when children under five years are present during day care hours. The fireplace is screened. There are no bodies of water observed during time of visit. The fire extinguisher is rated 2A 10B:C and is located by the entrance and the smoke alarm is located in the hallway and both meet requirements and are operational. Applicant stated that they will install a Carbon Monoxide detector. All poisons, detergents, cleaning compounds, and medicines are inaccessible to children in care and are located in off limit areas with door locks and secured out of reach of children. Children’s toys and play equipment are available. The applicant has a working telephone/cell phone. Applicant indicated there are no firearms or other weapons in the home.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HAMIDI, SAMIRA FAMILY CHILD CARE	FACILITY NUMBER: 376629427
	VISIT DATE: 09/13/2022

NARRATIVE

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Applicant maintains documentation of proof of control of property for review by the Department. Applicant has submitted Mandated Reporter AB1207 training certification. Applicant has completed the 8 hours of preventative health. Pediatric CPR and First Aid certifications expire on 7/2024. Required documents are posted. Applicant and adult residents in the home have criminal record clearances and/or exemptions on file. Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted. Immunization records per SB792 were reviewed and are in compliance. LPA advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change. Applicant states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. The hours of operation are Monday through Sunday, 12:00 a.m. to 11:00 p.m.

Applicant does not plan on providing Incidental Medical Services (IMS) to clients at this time. IMS policy was discussed. 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 New Provider Resource Packet was reviewed with the applicant including information on the following: Safe Sleep, Lead Exposure, SIDS, shaken baby, child abuse reporting, community resources, children’s records, facility records, required postings, immunizations, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log. Applicant was also informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care.

LPA discussed the maximum capacity for a large family child care home: 12 children: no more than four infants (infants mean any children under 24 months) and 8 children over the age of 2; 14 children: no more than 3 infants and 11 older children with at least two school age children: one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HAMIDI, SAMIRA FAMILY CHILD CARE	FACILITY NUMBER: 376629427
	VISIT DATE: 09/13/2022

NARRATIVE

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with 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 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.

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
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.

Southern California Child Care Advocate information was provided and applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov. Duty Line phone number was also was provided: (619) 767-2248.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HAMIDI, SAMIRA FAMILY CHILD CARE	FACILITY NUMBER: 376629427
	VISIT DATE: 09/13/2022

NARRATIVE

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

Hazardous items on east side of house to be made inaccessible to children in care
Plants with thorns to be made inaccessible to children in care
Hazardous items in upstairs cabinet and bathroom to be made inaccessible to children in care
Carbon Monoxide detector to be installed
Staircase to be fenced or barricaded

A Regular Large Family Child Care Home license may be issued upon final file review.

Exit interview conducted and report was reviewed with the applicant, Samira Hamidi.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC809 (FAS) - (06/04)

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