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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503912077
Report Date: 06/12/2023
Date Signed: 06/12/2023 01:49:20 PM

Document Has Been Signed on 06/12/2023 01:49 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MOHAMMADI, HALIMA FAMILY CHILD CAREFACILITY NUMBER:
503912077
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/12/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Halima MohammadiTIME COMPLETED:
02:00 PM
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On 06/12/2023, Licensing Program Analyst (LPA), Jeovanna Yanez met with Applicant, Halima Mohammadi for a change of location/pre-licensing inspection. Applicant and two minor children reside in the home. Background clearances are discussed and LIS 531 is signed indicating that the adults currently living in the home and/or providing care and supervision to children have a criminal record clearance.

Facility was inspected inside and outside as shown on the facility sketch and the following items were discussed:
· This is a two story three bedroom, three bathroom home and upstairs area will be off-limits to the day-care children. There is a gate at the bottom of the stairs making upstairs area inaccessible. Care and supervision will be provided in the downstairs living room, kitchen, dining room (daycare room), and hallway bathroom. Off limits rooms/areas are made inaccessible via door knob covers and/or safety latch.
· There is a fireplace in the living room that applicant states will not be used during day-care hours.
· In the living room, LPA observed a flat screen television mounted on a stand and comfortable furnishings. In the dining room, LPA observed one play yard, a colorful tunnel, and other safe games, toys, and books for the children. Children will nap on mats, infants will nap on play yards. Applicant understands she is to supervise children at all times. LPA provided applicant with Individual Sleeping Plan and Safe Sleep handout.
· Facility has 2A10BC fire extinguisher, smoke alarm, carbon monoxide alarm and first aid kit in place.
· Applicant’s Pediatric CPR and First Aid certification was completed through American Heart Association and expires on May 10, 2024. (CONTINUED ON 809-C)
SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2023
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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MOHAMMADI, HALIMA FAMILY CHILD CARE
FACILITY NUMBER: 503912077
VISIT DATE: 06/12/2023
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· Preventative Health and Safety Course with Prevention of Lead exposure certification was completed on April 30, 2022.
· Knives are stored in a top kitchen cabinet. Medications are stored in a top shelf in an off-limits storage closet. Cleaning compounds are stored in the off-limits garage.
· Advised applicant fire drills are to be conducted once every 6 months and must be documented with date and time. A fire drill log was provided as an example.
· Applicant is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
· There are no bodies of water in the home or premises.
· Applicant states there are no pets in the home or on the premises.
· Applicant states there are no firearms or ammunition in the home or premises.
· Applicant is reminded that any advertising (of day-care) such as business cards, flyers/posters, and/or signs must include facility number as per Title 22 Regulation "Advertisements and License Number" 102359 (a).
· Applicant is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Applicant states the home is smoke-free.
· Applicant states she will not be transporting day care children. Applicant understands that she must have proper car restraints and/or car seats for all the children under her care when transporting children.
· LPA inspected the fenced backyard which will be off limits to the day care children. LPA observed gardening tools, pieces of wood scattered, and two parts of the fence that need to be repaired/replaced. Prior to use, Applicant will contact Licensing to come clear backyard for day-care use. Applicant states that she will utilize her unfenced front yard for outdoor play. Applicant understands that she must have 100% direct visual supervision of the day care children when playing outdoors in an unfenced area.
· SB 792 immunizations verified and on file.
· Applicant completed the Mandated Reporter Training on April 13, 2022.
(CONTINUED ON 809-C)
SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MOHAMMADI, HALIMA FAMILY CHILD CARE
FACILITY NUMBER: 503912077
VISIT DATE: 06/12/2023
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· LPA discussed safe sleep regulations and Safe Sleep Concepts were given to applicant.
· Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. 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.

Required postings, forms packet, which included Parent Notification Requirement and LIC9224 were provided and discussed in detail. Applicant is advised that she may access CCLD website at www.ccld.ca.gov for additional forms and licensing updates. Applicant is also reminded that it is her responsibility to read the regulations periodically. Applicant states she will operate her day care Monday through Friday from 6:00 am to 12:00 am. No overnight care will be provided.

LPA & applicant discussed the Community Care Licensing website: LPA and applicant discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.



Pending a final review of application file, licensure as a Small Family Day Care Home capacity of 8 children ages under 18 years will be recommended effective 06/13/2023.
SUPERVISORS NAME: Rene Mancinas
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
LIC809 (FAS) - (06/04)
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