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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624091
Report Date: 09/24/2021
Date Signed: 09/24/2021 10:20:35 AM

Document Has Been Signed on 09/24/2021 10:20 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:HAMIDI, ROINA & AHAMDWALIFACILITY NUMBER:
343624091
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/24/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Roina HamidiTIME COMPLETED:
10:40 AM
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On Friday, September 24 2021, at approximately 9:15 AM, Licensing Program Analyst (LPA) Alize Tillery met with Applicant Roina Hamidi for the purpose of conducting an announced change of location pre-licensing inspection. During today's inspection, applicant, her husband and their daughter were present in the home. Applicant and all other adults (husband) have criminal record clearances on file. Applicant plans to operate Sunday – Saturday from 7:00 AM to 7:00PM. Applicant submitted proof of control of property and landlord notification form. Applicant can care for up to 6 children.

A health and safety inspection was conducted inside and out of the home. The one story facility includes 3 bedrooms, 1 bathroom, kitchen, dining room area, living room, an unfenced front yard and fenced backyard. The Off-limits areas include: bedroom #3. Licensee acknowledged that children may never enter these off-limit areas.



There is not a fireplace in the home. Toxic and hazardous items are inaccessible to children and out of children's reach. Sharp knives are stored in the kitchen above the refrigerator, out of children's reach. Applicant will have medications stored in the kitchen, out of children’s reach. A first aid kit, a functioning smoke detector, carbon monoxide detector and a full 2A10BC fire extinguisher were observed in the home. LPA observed all required licensing postings along with COVID19 posters.

Report continues on LIC809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: HAMIDI, ROINA & AHAMDWALI
FACILITY NUMBER: 343624091
VISIT DATE: 09/24/2021
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LPA discussed Unusual Incident Report requirements with applicant. Applicant completed the required Preventative Health and Safety course and Applicant has a current EMSA certified CPR and First Aid card which expires 04/04/2023. Applicant is exempt from the Mandated Reporter Training due to the language barrier. Applicant stated there are no weapons in the home and there are no bodies of water on the premises. Applicant understands that prior to making alterations or additions to the home or grounds, she shall notify the Department of the proposed changes.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant was encouraged to visit the Department’s website at www.cdss.ca.gov for more information regarding child care updates, forms, regulations and legislation. This report and a Notice of Site Visit was reviewed and provided to Licensee. Licensee acknowledges the Notice of Site Visit must be posted for 30 days.



As of today, September 24, 2021, facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only. Infants are children under the age of 2.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC809 (FAS) - (06/04)
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