394500677-9-14-2022-53-CC-TDIP-CJ9RLJ-20220914130713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500677
Report Date: 09/14/2022
Date Signed: 09/14/2022 01:07:24 PM

Document Has Been Signed on 09/14/2022 01:07 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:	NASIRI, JAMILA		FACILITY NUMBER:	394500677
ADMINISTRATOR:	JAMILA NASIRI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 305-6122
CITY:	MANTECA	STATE: CA	ZIP CODE:	95337
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/14/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jasmila Nasiri		TIME COMPLETED:	01:15 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	On 09/14/2022 at 10 AM, Licensing Program Analysts (LPAs) Tiffanie Diep and Katy Maestas met with Applicant, Jamila Nasiri, for the purpose of conducting a pre-licensing inspection for a change of location. Applicant’s three older children were also present during today's inspection. Applicant’s primary language is Pashto and daughter assisted with translation during the inspection. Applicant is requesting a change of location from previous facility (#376100421) to current location. Current location was cleared for fire by Manteca Fire Department on 08/11/2022. A health and safety inspection of the home’s interior and exterior was conducted. The two-story home has four bedrooms and two-and-a-half bathrooms. There is also a family room, dining room, living room, kitchen, and laundry room. LPAs verified all knives and toxic and hazardous items were inaccessible to children. LPAs observed cleaners stored in kitchen cabinets out of reach and inaccessible to children. Functioning smoke and carbon monoxide detectors were observed in the hallway at the base of the stairs. A 2A10BC fire extinguisher was observed in the kitchen and first aid kit was observed in the family room. Applicant stated there are no weapons or pets in the home. LPAs observed a fireplace that was barricaded by a metal screen. The outdoor play area was inspected and is surrounded by a wooden fence. LPAs observed overgrown grass in the play area. Applicant stated she will mow the grass and provide LPA with photos upon completion. There are no bodies of water on the premises. The off-limits areas in the home are the garage and the entire second floor. The garage will remain inaccessible to children in care by a doorknob cover. Stairs to the second floor will remain inaccessible by a baby gate. Applicant understands that if any structural changes are made to the home, Licensing must be notified prior to construction. Applicant also understands that prior to use of any off-limits area, Licensing must be notified and an inspection must be completed by a LPA before children are allowed in the area. Continues on 809-C

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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: NASIRI, JAMILA	FACILITY NUMBER: 394500677
	VISIT DATE: 09/14/2022

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.

LPAs discussed the mandated reporter training requirement with Applicant. Health and Safety Code 1596.8662 requires all licensed child care providers, applicants, administrators, and employees of a licensed child care facility to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicant’s current Mandated Reporter Training certificate expires on 08/23/2024. Current pediatric CPR and first aid training was verified and expires on 06/11/2024. LPAs discussed the requirement to renew CPR and first aid certifications every two years prior to expiration. Completion of preventative health and safety training including nutrition and lead exposure was verified.

LPAs 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. LPAs 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. LPAs discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months. LPAs provided a copy of the LIC 9227, Individual Sleeping Plan, for infants under 12 months.

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

Continues on 809-C

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: NASIRI, JAMILA	FACILITY NUMBER: 394500677
	VISIT DATE: 09/14/2022

NARRATIVE

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LPAs reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to Applicant. Proof of required immunizations for Applicant was verified. Applicant understands that records for children and staff, including a current children’s roster, are to be maintained according to Title 22 Regulations and accessible to Licensing for up to three years. Applicant understands that fire and disaster drills must be conducted and documented once every six months. Applicant understands that if an unusual incident occurs, a report shall be made to the Department by telephone, e-mail, or fax within 24 hours and the LIC 624B, Unusual Incident/Injury Report - Family Child Care Home, shall be submitted within seven days to remain in compliance. Applicant understands that licenses are not transferable, and once licensed, the licensee must live in the home and be present for 80% of the operating hours.

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 e-mail communication. Licensee was encouraged to visit the Department’s website at http://ccld.ca.gov/ for information regarding child care updates, forms, regulations and legislation pertaining to Family Child Care Homes.

A provisional license for a large Family Child Care Home is granted effective today, September 14, 2022. The facility is approved to serve a maximum capacity of 14 children with no more than 3 infants, 1 child enrolled in transitional kindergarten or above, and 1 child at least age 6. Infants are children under the age of 2. Without an assistant present, the ratios revert to those for a small Family Child Care Home. The provisional license will expire on December 14, 2022. A regular license will be issued once the following is completed and submitted to LPA:

Photos to show that the overgrown grass and debris in outdoor play area has been removed

An exit interview was conducted and report was reviewed with the applicant, Jamila Nasiri. A copy of the report was provided to Applicant. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

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