Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624620
Report Date: 08/21/2018
Date Signed: 08/21/2018 02:46:29 PM

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:8CENSUS: 3DATE:
08/21/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Benafsha AstanzaiTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Yolanda Baez and Angel Richards, made an unannounced visit for the purpose of a annual inspection. LPAs met with Licensee Benafsha Astanzai. During this visit there were 3 children in care (2 infants and 1 toddler).

LPAs toured the home, this is a 2 bedroom and 2 bathroom apartment located on the second story. The primary child care areas are the following: the living room, the kitchen, the day care area (next to the kitchen), the master bedroom, and the bathroom located in the master bedroom. The following areas have been inaccessible through the use of door locks or safety gates: the second bedroom and the hallway bathroom. There are a sufficient amount of age appropriate toys, games, and books available. The home has plenty of space for the children to eat, sleep and play, and was a comfortable temperature during this visit. Upon walking through the facility, LPAs observed that Licensee does not have window locks on the windows in the living room or the windows in the master bedroom (accessible to children in care). Windows in the living room are near couches that are easily climbable by the children in care, see 809D for cited deficiency. A child was observed to be swaddled tightly in a playpen in the master bedroom, see 809D for cited deficiency. Licensee took the infant child out of the swaddle immediately. Licensee stated that she takes the children to a nearby park for outdoor activities. The fire extinguisher is full, of regulation size, and located in the kitchen. There is no fireplace on the property. There are not any stairs in the property. There is a functional smoke alarm and carbon monoxide monitor at the facility. LPA Baez verified a working telephone and all required forms are posted. There are no bodies of water present at the facility. Licensee stated that there are no firearms or ammunition on the property. LPAs verified that all adults living or working in the home have been fingerprint cleared and associated. Licensee has requested that an adult be removed from association list because adult no longer resides at the facility since September. LPAs reviewed children's files, child care roster, and the emergency drill log. The last emergency drill was conducted on 08/13/18. Licensee's pediatric CPR/FA certification expired on 12/16/19. LPA Baez reviewed physical plant, bodies of water, storage of hazardous items, Shaken Baby Syndrome, SIDS, emergency drills, and child care roster.

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2018
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 CARE
FACILITY NUMBER: 376624620
VISIT DATE: 08/21/2018
NARRATIVE
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LPA reminded Licensee that walkers, jumpers, exersaucers, and bouncers are not permitted for use in the day care. IMS was discussed. Licensee is not currently providing IMS, Licensee understands that a written plan of operation for IMS must be submitted prior to enrolling any child who requires IMS. 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 http://www.ada.gov/childqanda.htm

New immunization law (SB792) was discussed with Licensee. Licensee understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Licensee is not compliant with SB792, see 809D for cited deficiency. LPA discussed AB1207, Licensee understands that all personnel must have certificates present and available for review at the facility. To access the Mandated Reporter Training please visit www.mandatedreporterca.com. Facility is not compliant with AB1207, see 809D for cited deficiency.

LPAs obtained updates on the following forms:

  • LIC 279: Application (to reflect current adults living in the home)
  • LIC 610A: Emergency Disaster Plan (to update/verify temporary relocation sites and phone numbers)
  • LIC 999A: Facility Sketch (to verify rooms in use)
  • LPA requested an updated rental/lease agreement and obtained an updated LIC 9151

NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov

Duty Line: (619) 767-2248, Open Monday thru Friday 8am - 5pm

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2018
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 CARE
FACILITY NUMBER: 376624620
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2018
Section Cited
CCR
102423(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment. Requirement was not met as evidence by LPAs' observations. LPAs Richards and Baez observed an 8 month old infant to be swaddled tightly in a blanket in a playpen located in the masterbedroom. This poses a potential risk to
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Licensee corrected immediately by taking the child out of the swaddle. Licensee stated that she would provide a hand written statement of her understanding of the importance of safe sleep procedures for infants.
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the health and safety of the clients in care.
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Type B
08/28/2018
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child. Requirement was not met as evidence by LPAs' observations. Licensee does not have locks in place on the living room window and the windows located in the master bedroom that is accessible to day care children. Licensee's
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POC visit will be conducted after 08/28/18.
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apartment is located on the second story and windows in both the master bedroom and the living room are open more than 4 inches. Windows in the living room are near couches that are easily climbable by the children in care. This poses a potential risk to the health and safety of the clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2018
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 CARE
FACILITY NUMBER: 376624620
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2018
Section Cited
HSC
1596.622(a)(1)
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Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles... Requirement was not met as evidence by Licensee's file review. Licensee does not have her immunization record to show proof of immunization for Pertussis,
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Licensee stated that she will obtain her immunization record and send LPA baez a photo of immunization record by POC date of 09/04/18.
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measles, and influenza. This poses a potential risk to the health and safety of the clients in care.
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Type B
08/28/2018
Section Cited
HSC
1596.866(a)(b)(1)
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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years
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Licensee stated that she will complete the course on the mandated reporter website and send LPA Baez the certificate for AB1207 by given due date of 08/28/18.
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following the date on which he or she completed the initial mandated reporter training. Requirement not met as evidene by file review. Licensee does not have certificate to show compliance with AB1207. This poses a potential risk to the health and safety of the clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2018
LIC809 (FAS) - (06/04)
Page: 4 of 4