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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624620
Report Date: 01/11/2022
Date Signed: 01/11/2022 09:28:47 AM

Document Has Been Signed on 01/11/2022 09:28 AM - 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ASTANZAI, BENAFSHA FAMILY CHILD CAREFACILITY NUMBER:
376624620
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
01/11/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Licensee, Benafsha Astanzai TIME COMPLETED:
08:40 AM
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Regional Manager (RM) Kimberly Hall, IB Investigator Thomas Smith and Licensing Program Analyst (LPA) Jennifer Lott conducted an unannounced visit at the above referenced facility, on today's date, to deliver a Temporary Suspension Order (TSO) to Licensee Benafsha Astanzai.

The Temporary Suspension Order (TSO) and all related documents were provided to the Licensee, which include: Temporary Suspension Order, Statement to Respondents, Government Code Sections, Accusation, Notice of Exclusion, Request for Discovery and Notice of Defense (2 copies).

The Regional Manager explained the contents of the packet to the Licensee. The Licensee was advised that all care and supervision of children must cease by 6:00 pm on 01/11/22. The LPA posted the TSO notice on the entrances to the facility and the Licensee was informed that to remove or conceal this notice will result in criminal action and/or a $500.00 civil penalty. Licensing representatives use the Licensee's Facility Roster to provide letters to parents to notify them of the closure and provide them with the Resource and Referral number to assist them in locating other child care.

Due to the serious injury sustained an Enhanced Civil Penalty is under review per Heath and Safety Code Section 1597.58. Citations and Civil Penalties will be issued at a later date.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2022
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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