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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624357
Report Date: 08/15/2023
Date Signed: 08/15/2023 01:10:10 PM

Document Has Been Signed on 08/15/2023 01:10 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SAFI, KARISHMAFACILITY NUMBER:
343624357
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
08/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Muhibur-Rahman SafiTIME COMPLETED:
01:45 PM
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On Tuesday, August 15, 2023 at 11:20 AM, Licensing Program Analyst (LPA) Tanya Washington met with Licensee's father Muhibur- Rahman Safi for an unannounced plan of correction inspection to clear deficiencies cited on 07/11/2023. Also present in the home is Licensee's mother Shabnam Safi. During the inspection LPA used Language Link, translator #15950. Licensee's parents speak Pashto. Licensee was not present during today's inspection. LPA observed four children in the home related to the Licensee and her parents. There were no daycare children in care during today's inspection and Licensee's father stated that children have not been in care since August 9th, 2023.

LPA observed the following corrections:
- There are two playpens for children who are under two years old. LPA did not observe any items in the playyards.
- LPA observed an operational carbon monoxide detector
- LPA reviewed files for fourteen children who are enrolled at the facility
- LPA observed a current fire drill log and a children's roster
- LPA observed a current CPR and First Aid certificate for Licensee's mom, and the Licensee is signed up to renew her certification.

All deficiencies previously cited are cleared as of today. Notice of site visit posted and shall remain posted for 30 days. Appeal rights are provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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