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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624066
Report Date: 11/18/2021
Date Signed: 11/18/2021 11:23:05 AM

Document Has Been Signed on 11/18/2021 11:23 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:TOKHI, SAHARFACILITY NUMBER:
343624066
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/18/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sahar TokhiTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Gagandeep Singh and Josiah Gathing met with applicant, Sahar Tokhi, for a scheduled pre-licensing inspection at the facility. Applicant has license (343623693) for child care home at a different location and applied for new license due to change of location. Applicant lives in two story single family home with three minor children. The house is owned by applicant’s adult daughter, who does not live at this location. All the adults living in the house has criminal background clearance on file. Hours of operation will be Monday to Friday 7:30 AM to 9:00 PM. Child care will be provided in areas: Living room, Sunroom, Kitchen, Hallway, Bathroom in hallway, one bedroom in hallway on left side of bathroom and Backyard. Off limit areas: Entire second floor, Two bedrooms on ground floor, Garage and two storage sheds in the backyard. All off limits areas must remain inaccessible to children. Isolation of an ill child will be in the bedroom next to the bathroom. Applicant was notified that prior to use of any off limits area, the department must be notified.

LPAs inspected the entire home with the applicant for health and safety hazards. The house has proper temperature and ventilation. All of the toxic or dangerous materials are stored in off limit areas and on top shelves. Stairs are barricaded with gate. There are no pools, spas or other bodies of water. Per licensee, there are no pets in the house. The house has a working telephone, fully charged 3A40BC fire extinguisher, first aid supplies, smoke detector and carbon monoxide detector. As per the applicant, there are no firearms or weapons in the home. All unused electrical outlets are properly covered. All cabinets in the kitchen and drawers have child protective locks installed. Knives are stored in high cabinet. Stove in kitchen has child protective covers installed on the knobs. Discipline policy will be to talk to the child. Applicant is advised all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with copy of CA DL or CA ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.
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SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: TOKHI, SAHAR
FACILITY NUMBER: 343624066
VISIT DATE: 11/18/2021
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LPA discuss licensing regulations, safe sleep procedures and provide a copy of PIN 20-24-CCP. Applicant has submitted record of all the required immunization, CPR valid until June 2022 and Mandated reporter training certificate valid until January 09, 2023. Applicant understands that fire/earthquake drills are to be conducted every 6 months and recorded. LPAs observed the applicant has a log in place. Applicant understands that baby walkers, bouncers, and excersaucers are not allowed. Smoking is prohibited in family child care homes. Licensee was informed about the Provider Information Notices (PINs) on CCLD website.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

LPAs reminded that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

The applicant is encouraged to frequently visit out website at http://www.ccld.ca.gov/ for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Prior to issue license, facility needs to complete the following:
- Install the cushion on the corners of fireplace.
- Pay the licensing fee.

Copy of this report was reviewed and provided to applicant. This report will be kept in the facility file and will be made available for public review upon request. Desk Duty is available Monday through Friday between 8 AM - 5 PM at (916) 263-5744.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
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