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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624382
Report Date: 06/24/2022
Date Signed: 06/24/2022 10:35:03 AM

Document Has Been Signed on 06/24/2022 10:35 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:NAZRABI, KHALIDAFACILITY NUMBER:
343624382
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/24/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Khalida NazrabiTIME COMPLETED:
10:45 AM
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This is a Change of Location from previous facility number 343624262.

Licensing Program Analyst (LPA) Kelly Ferrara conducted a Change of Location inspection and met with applicant Khalida Nazrabi. LPA conducted a health and safety inspection of the applicant’s two story, five bedroom, two bathroom home. Facility hours of operation are Monday through Friday 8 AM to 6 PM.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Off limit areas include: Entire upstairs. Applicant was advised that the children can walk through the garage to enter the home, but children may not play or spend time in the garage. Applicant understands that children may not enter off limit areas and any changes made must be cleared through Licensing. Chemicals, knives, medications, and hazardous items are all stored in a way that is inaccessible to children. LPA advised that poisonous items must be locked. LPA observed the smoke and carbon monoxide detector are functioning properly. LPA observed a 2A-10-BC fire extinguisher. Applicant stated there are no firearms in the home and LPA did not observe any bodies of water on the premises.

Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA reviewed capacity requirements and limitations with the applicant. Exit interview was conducted and a copy of the report was given to the applicant.

As of today’s date, June 23rd 2022, the new home is licensed and ready to operate.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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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