343625193-8-31-2023-03-CC-KWIS-CV8NLH-20230831103333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343625193
Report Date: 08/31/2023
Date Signed: 08/31/2023 10:33:42 AM

Document Has Been Signed on 08/31/2023 10:33 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:	GHAYASI, FAREEMA & ABDUL		FACILITY NUMBER:	343625193
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	08/31/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Fareema Ghayasi		TIME COMPLETED:	10:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 31, 2023, Licensing Program Analyst (LPA) Kyrsten Williams and Licensing Program Manager (LPM) Seychelle De Luca met with Applicant, Fareema Ghayasi, for the purpose of an announced change of location pre-licensing inspection. Applicant was previously licensed under license #343624044. During today’s visit, applicant’s husband was also present in the home and assisted with translation. All individuals subject to criminal background review have obtained a criminal record clearance. LPA supported applicant with completing a new LIC 279 Application form to update the applicant name. Census included one child. Hours of operation: Monday through Friday from 7:00 AM to 7:00 PM. A health and safety inspection was conducted on the interior and exterior of the home. The home has four bedrooms which includes two bathrooms, kitchen, a living room, laundry room, garage, and backyard. Off-limit areas include bedroom #3, bedroom to the left of kitchen, garage, and the left side of the backyard. Toxic and hazardous items, sharp knives, and medications are inaccessible to children. LPA observed a functioning smoke detector, carbon monoxide detector, and 2A10BC fire extinguisher within the home. Applicant stated that there are no poisons in the home. LPA advised the applicant that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. Applicant stated there are no weapons or bodies of water on the premises. LPA advised the applicant to fix the wire fence gate in the backyard. Applicant has completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training. Applicant is enrolled in an EMSA approved pediatric CPR/First Aid training. Applicant understands CPR/ First Aid training must be completed every two years. Mandated reporter training is not required for the applicant due to it not being available in her primary language. LPA discussed capacity and supervision with applicant. LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. Applicant understands a current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer attending.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GHAYASI, FAREEMA & ABDUL	FACILITY NUMBER: 343625193
	VISIT DATE: 08/31/2023

NARRATIVE

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Applicant understands that if an unusual incident occurs, licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance.

LPA explained to applicant that if they relocate and wants to continue to provide care, they must submit a change of location application and have the new home inspected. Applicant understands that if any structural changes are made to the home, licensing must be notified prior to construction. Applicant understands that if they want to make any off-limit area an on-limits area, licensing must be notified and LPA must do an inspection before children are allowed in the area. Applicant understand that licenses are not transferable, and once licensed, licensees must live in the home and be present for 80% of the operating hours each day.

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant provided proof of control of property. The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (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.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GHAYASI, FAREEMA & ABDUL	FACILITY NUMBER: 343625193
	VISIT DATE: 08/31/2023

NARRATIVE

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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-andresources/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.

On this date, 08/07/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication

The following corrections are needed prior to licensure:

1. Completion of EMSA Approved CPR/First Aid Training
2. Barricade the fireplace
3. Proof the fence gate in between the yards is fixed

Exit interview conducted and report was reviewed with the applicant, Fareema Ghayasi.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC809 (FAS) - (06/04)

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