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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500403
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:20:35 PM

Document Has Been Signed on 06/23/2022 03:20 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:KHAN, RABEEHAFACILITY NUMBER:
394500403
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rabeeha KhanTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Christopher Jackson and Erwin Tjhia met with licensee Rabeeha khan, for an unannounced random annual inspection and toured areas of the home accessible to children in care. Off-limit areas include bedroom number 1, bedroom number 2, garage and backyard. Licensee acknowledged that children may never enter these off-limit areas. During today inspection licensee requested to add bedroom number 1 and backyard to the on limit area. LPA tour area and observe no hazardous items accessible for the children. On 06/23/2022 LPA will approve these area to be on limit area. In addition to today's annual inspection, the licensee has applied for a large license. The department has received a fire clearance from the Lodi Fire Department clearing the home for a large family home day care on 05/06/2022.

Licensee Rabeeha Khan was reminded that all adults 18 and over living or working in the home, 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 observed current CPR/First Aid certificates which expire on 03/10/2023. LPA discussed licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed 5 children’s files in care. LPA observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector and carbon monoxide detector meet regulation. The backyard is fenced and gated. There are no bodies of water observed.

Report Continues on 809-C
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: KHAN, RABEEHA
FACILITY NUMBER: 394500403
VISIT DATE: 06/23/2022
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LPA discussed the Mandated Reporter Training with licensee. Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. In addition, existing licensees must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English.

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.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations.

Effective today, 06/23/2022, LPA is granting a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the licensee and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the licesnee understands it must remain posted for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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