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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629751
Report Date: 10/15/2023
Date Signed: 10/23/2023 11:35:00 AM

Document Has Been Signed on 10/23/2023 11:35 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:SALEHI, FARZANA FAMILY CHILD CAREFACILITY NUMBER:
376629751
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
10/15/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Farzana Salehi and TIME COMPLETED:
11:50 AM
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On 10/23/23 at 10:15AM, Licensing Program Analyst (LPA) Luigi Gargaro conducted an announced prelicensing inspection with the applicant. Analyst met with the applicant Farzana Salehi and her spouse Zabihullah Salehi. The purpose of the visit is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The one floor, four bedroom, two bathroom house was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and smoke and carbon monoxide detectors meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Analyst inquired if there are any bodies of water or weapons in the home and the applicant replied no. A review of records on this date indicates that all adults or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

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. Applicant owns the home and provided proof of control of property in the form of a deed of trust that she submitted with her original application. First Aid and CPR expire on 09/20/25 for the applicant.

Applicant will be using the following rooms for childcare: the kitchen, the living room, the dining room and the day care bathroom. The following areas will be off limits: the four home bedrooms with inclusive master bathroom and the garage. All four bedrooms and the garage are made off limits with doorknob covers that are installed on their respective entry door handles.

The applicant has sufficient day care equipment available. The home has a fenced backyard available for outdoor activities. The yard has a shed in it that contains tools and applicant's personal items and is off limits to the day care. The shed is off limits with a latch and bolt installed by the applicant.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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: SALEHI, FARZANA FAMILY CHILD CARE
FACILITY NUMBER: 376629751
VISIT DATE: 10/15/2023
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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. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov.

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)/ (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 and applicant discussed California Megan's Law and he provided applicant with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis.

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.

Exit interview conducted and report was reviewed with the applicant, Farzana Salehi and her spouse. No corrections are needed, a license for 8 will be issued effective today. Community Care Licensing web site: http://ccld.ca.gov.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC809 (FAS) - (06/04)
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