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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215915
Report Date: 05/26/2023
Date Signed: 05/26/2023 01:44:34 PM

Document Has Been Signed on 05/26/2023 01:44 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:FAROOK FCC AKA SAFIA'S HOME DAYCAREFACILITY NUMBER:
566215915
ADMINISTRATOR:FATHIMA SAFIA FAROOKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 256-7872
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/26/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:FATHIMA SAFIA FAROOKTIME COMPLETED:
02:00 PM
NARRATIVE
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On May 26, 2023 at 11:00 am, Licensing Program Manager (LPM) George Mingle and Licensing Program Analysts (LPA) Susana Martinez met with licensee, Fathima Safia Farook for an office meeting at the Department of Social Services, Santa Barbara Regional Office. The purpose of the office meeting was to discuss recent substantiated complaint and cited deficiencies regarding the operation of the following Family Child Care Home: Farook FCCH #566215915, Pursuant to Title 22, Division 12 of the California Code of Regulations.

Concerns discussed:
  • Operations of a Family Child Care Home

  • Ratios/License

  • Safe Sleep
  • Personal Rights of Children

  • Reporting Requirements

In response to the discussion, Licensee has agreed to the following:
  • Licensee will submit a written statement indicating how she intends to maintain compliance with California Code of Regulations, Title 22, Division 12 at all times by 06/26/2023.
  • Licensee shall be placed on a compliance plan for 2 years.
  • Licensee is encouraged to review training videos on the following and write what she learned differently which will be due to the Department by 6/26/2023:
Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: FAROOK FCC AKA SAFIA'S HOME DAYCARE
FACILITY NUMBER: 566215915
VISIT DATE: 05/26/2023
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How Many Children can Attend a Family Child Care
https://ccld.childcarevideos.org/family-child-care-providers/how-many-children-can-attend-a-family-child-care-home/

Supervising Children in Family Child Care
https://ccld.childcarevideos.org/family-child-care-providers/supervising-children-in-family-child-care/
Children's Personal Rights in Child Care
https://ccld.childcarevideos.org/family-child-care-providers/childrens-personal-rights-in-child-care/
- https://ccld.childcarevideos.org/

Reporting Requirements
https://ccld.childcarevideos.org/family-child-care-providers/child-care-reporting-requirements/

Resources provided to the Licensee:
- Technical Support Program (TSP) Brochure
- Tips to Protect Children from Environmental Threats (flyer)
- What Does A Safe Sleep Environment Look Like? (flyer)
- Ratio Guide (flyer)
- Regulation: 102416.5 Staffing Ratio and Capacity
- Regulation: 102417 Operations of a Family Child Care Home
- Regulation: 1024425 Infant Safe Sleep
- Regulation: 102416.2 Reporting Requirements
- Infant Sleep Log (template)
- Individual Infant Sleeping Plan (LIC9227)
- Safe Sleep Frequently Asked Questions

Upon receipt, Licensee shall provide copies of this licensing report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. The Acknowledgement of Receipt (LIC 9224) to parents shall be completed and signed by each parent/guardian with copies maintained in each child's file. Licensee was given a copy of LIC9224 Acknowledgement of Receipt of Licensing Reports.

Exit interview conducted and report reviewed with licensee Fathima Safia Farook.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
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