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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408377
Report Date: 07/19/2024
Date Signed: 07/19/2024 03:52:02 PM

Document Has Been Signed on 07/19/2024 03:52 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:AFJEI, BATOOLFACILITY NUMBER:
434408377
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
07/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Batool AfjeiTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Annual/Random inspection. LPA met with Licensee Batool Afjei and explained the reason for the inspection. The purpose of this inspection is Licensee also applied for a change of capacity to be large Family Child Care Home (FCCH). Licensee has at least one year of experience as a licensee of a small FCCH to apply for a large FCCH. A fire clearance was granted on 06/13/2024. Licensee owns the home. Present during today's inspection were Licensee, her assistant, and four children, whom all were infant age. Licensee was within ratio during today's inspection.

There is a board to post required postings, such as license and notification of parent's rights. The hours of operation are Monday through Friday 7:30AM to 5:30PM. Licensee uses her cell phone.

LPA toured the inside and outside of the home with Licensee. The off-limit areas of the home are the dining room, living room, office, kitchen, and entire upstairs. Licensee uses the converted garage as a walkway for drop-off. Licensee understands that the converted garage and any areas that are off-limit cannot be used for the FCCH. LPA reminded Licensee that any off-limit areas needs to be barricaded, such as kitchen. There is a gate to block off the kitchen. Children do not have access to the stairs in the home. There is a fireplace that is barricaded. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. LPA discussed with Licensee that anything that states to keep out of reach of children needs to be inaccessible, such as diaper cream and air fresher. There are toys and equipment for children. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide. Licensee stated that there are no weapons, such as firearms, stored in the home.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: AFJEI, BATOOL
FACILITY NUMBER: 434408377
VISIT DATE: 07/19/2024
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--------------------continuation of 809 dated 07/19/2024 page 1--------------------

The backyard is off-limits to the children. There is a pool and jacuzzi in the backyard. There is fencing around the pool and jacuzzi that swing outward, self-latches, and does not obstruct the view of the pool.

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.

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: https://www.ada.gov/resources/child-care-centers/.

Licensee does not transport children, but understands that children cannot be left alone and unattended in parked vehicles. Licensee also understands that any food containers brought from home needs to have the child's name on it.

A copy of the facility roster was obtained. The records reviewed include but not limited to immunization records and parent's rights. LPA discussed with Licensee that immunization records need to be transferred to PH 286.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: AFJEI, BATOOL
FACILITY NUMBER: 434408377
VISIT DATE: 07/19/2024
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Licensee has a valid CPR/1st Aid, which expires on 02/2026. Licensee completed the Mandated Reporter training on 10/16/2023. Licensee was reminded that the Mandated Reporter training requires renewal every two years. Licensee's immunization record for pertussis and influenza are on file. Licensee's proof that she completed blood titer to check for measles is on file, but there is no results. Licensee will submit results to Licensing.

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

LPA reminded Licensee that when Licensee does not have an assistant, Licensee can only care for up to 8 children at any one time in the home.

Licensee is the only adult living in the home. Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.
-------------------continues on 809 dated 07/19/2024 page 4-------------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: AFJEI, BATOOL
FACILITY NUMBER: 434408377
VISIT DATE: 07/19/2024
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During the exit interview, the LICENSEE, Batool Afjei, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

Licensee will submit the following:
- result for measles
- LIC 9227 and LIC 9224 for C-1
- PH 286 for C-2, C-3, C-4
- updated LIC 999A to reflect kitchen being off-limits

As a result of this inspection, no deficiencies were issued. Exit interview conducted and report was reviewed with Licensee Batool Afjei. Licensee was advised that upon review and approval of Licensing Program Manager that a license for a large FCCH was be issued. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5