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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100878
Report Date: 09/28/2021
Date Signed: 09/28/2021 11:00:54 AM

Document Has Been Signed on 09/28/2021 11:00 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JAFARI, MASOOMA FAMILY CHILD CAREFACILITY NUMBER:
376100878
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/28/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Masooma JafariTIME COMPLETED:
11:15 AM
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On 9/28/21 Licensing Program Analyst (LPA) Michael Morales-DeSilvestore conducted an announced Pre-Licensing inspection with the applicant. The 2 bedroom, 1 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Applicant states that operating hours are Monday-Friday, 6AM to 9PM.

The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home. Applicant states that there are no weapons in the home. Applicant states that they have sufficient financial resources to sustain the license. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant rents the home and has provided the Landlord Notification for a maximum of 6 children. First Aid and CPR expire on 9/2023 and preventative health practices course was completed on 9/28/19 and licensee has completed the additional lead poisoning training on 9/23/21. Licensee needs to complete a mandated reporter training prior to issuance of the license. Staff immunization requirements per SB792 were met.

Applicant will be using the following rooms for childcare: Living room, dining area, kitchen, bedroom 1 and bathroom 1. The following areas will be off limits: bedroom 2. The home has a detached garage that will remain off limits. The applicant has sufficient toys and equipment available. The home has a fenced patio for outdoor activity.

Provider is reminded to adhere to all applicable laws and regulations. The laws and regulations can be found on the Department of Social Services website:
https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers/laws-and-regulations
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JAFARI, MASOOMA FAMILY CHILD CARE
FACILITY NUMBER: 376100878
VISIT DATE: 09/28/2021
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LPA reviewed information with the applicant on child abuse reporting, adults living or working in the home, car seat law, shaken baby syndrome, SIDS and safe sleep, effects of lead poisoning, Incidental Medical Services, and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed the following with applicant or Licensee: maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.

LPA discussed and provided applicant with the following: Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov. In addition, for common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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.

The following corrections are needed prior to the issuance of the license: mandated reporter training certificate.
LPA informed applicant to submit the certificate to the Department by the due date of 10/28/21.
Once all corrections are made a small family child care home license will be granted.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Michael Morales-DeSilvestore
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
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