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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624357
Report Date: 11/09/2023
Date Signed: 11/09/2023 09:45:29 AM

Document Has Been Signed on 11/09/2023 09:45 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SAFI, KARISHMA AND SAFI, SHABNAM BIBIFACILITY NUMBER:
343624357
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 15CENSUS: 1DATE:
11/09/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Karishma SafiTIME COMPLETED:
09:45 AM
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On November 9, 2023 at 8:30 AM, Licensing Program Analysts (LPAs) Tanya Washington and Lea Habtom met with Licensee Karishma Safi for an unannounced case management inspection to increase capacity to the maximum number of 14 children. LPA used Language Link for assistance with interpretation from 16786. Upon arrival, both Licensees and one minor child related to the Licensees were present in the home. There were no day care children in care during the inspection. LPA reminded Licensees that children related to them count in ratios until they turn 10 years old. Everyone residing in the home have obtained the required fingerprint clearance. Facility hours and days of operation are Monday- Friday from 8 AM to 10 PM.

Licensees rent the apartment and have permission from the apartment management to watch up to 14 children (signed consent form LIC9149 is on file). LPA discussed capacity options with and without an assistant and when the Licensee or the assistant are alone they divert to small license ratio requirements.

On November 3, 2023, Sacramento Metropolitan Fire Department granted a fire clearance.

The off limit areas in the home are: entire second floor and laundry room. Licensees acknowledged that children may never enter the off limit areas of the home. The facility does not have a fenced backyard or patio area, Licensees were advised to provide 100% supervision when children play outside. Per licensee, there are no weapons on the premises. Infant safe sleep guidelines were discussed.

There is a pool in the apartment complex which is fenced according to Title 22 Regulations.
Both Licensees have current CPR and First Aid certification.

EFFECTIVE TODAY, 11/09/2023 THE FACILITY IS LICENSED TO SERVE A MAX. CAP OF 12 (WHEN THERE IS AN ASSISTANT PRESENT): WITH NO MORE THAN 4 INFANTS.
OR MAX CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. Notice of site visit posted and appeal rights were provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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