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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101490
Report Date: 05/03/2023
Date Signed: 05/03/2023 02:38:22 PM

Document Has Been Signed on 05/03/2023 02:38 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:AMIRI, BASMINA & EMAL FCCFACILITY NUMBER:
376101490
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/03/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Emal and Basmina TIME COMPLETED:
02:45 PM
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On 5/3/23 at 1:00 PM Licensing Program Analysts (LPAs), Adrian Mangina and Sherlynn Banas conducted an announced Pre-Licensing Change of Location Inspection with the Licensees, Emal and Basmina Amiri. Licensee rents the home and has provided lease as proof of control of property. Licensees will be moving into the facility in a week. The two bedroom two bathroom, one story home was toured and inspected to ensure an environment safe for the care and supervision of children. The 2A10BC fire extinguisher located in kitchen, smoke alarm located in the living room and carbon monoxide detector located in the living room meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee will use the fully fenced backyard for outdoor activities. Licensees advised to cover tree roots and broken patio tiles in back yard and to ensure that all protruding fence nails are flattened prior to licensure. Licensees state that there are no weapons in the home and have certified on the application 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.

Licensee Basima’s First Aid and CPR expire 12/2023 and Mandated Reporter Training AB 1207 expires on 3/ 28/25. Licensee Emal’s First Aid and CPR expires 1/2025 and Mandated Reporter Training AB 1207 expires on 1/10/25.Licensees immunization and TB requirements were met. Required documents have been posted, with exception of facility sketches. 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.

continued on LIC809 page 2
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: AMIRI, BASMINA & EMAL FCC
FACILITY NUMBER: 376101490
VISIT DATE: 05/03/2023
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LIC809 page 2

Licensees will be using the following rooms for childcare: living room, dining area, kitchen, hallway bathroom and bedroom . The following areas will be off limits: master bedroom and master bathroom. and are made inaccessible through use of door knob covers and safety latches. There is a wall heater in living room that must be screened or covered prior to licensure.

The new provider packet was reviewed with the Licensees including information on ratios and capacity, child abuse reporting, children’s records, immunizations, adults living or working in the home, car seat law, shaken baby syndrome, SIDS, safe sleep practices, effects of lead poisoning, and the YMCA Resource Center. Licensees were 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. LPAs and Licensees discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPAs discussed and provided Licensees with the following information:
· Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov.
· For common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

LPAs discussed the safe sleep regulations with Licensees and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed licensee 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.

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

continued on LIC809 page 3
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: AMIRI, BASMINA & EMAL FCC
FACILITY NUMBER: 376101490
VISIT DATE: 05/03/2023
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LIC809 page 3

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

LPAs reviewed with LIcensses 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. 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 platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Applicant has obtained landlord consent to care for up to 8 children, including any children living in the home under ten years old.

The following corrections are needed prior to the issuance of the license:

1) Cover tree roots in back yard
2) Remove hazards from side yard
3) Post correct LIC999A Facility sketches for this address
4) Cover broken patio tiles in back yard

Licensees understand that corrections must be submitted to the Department within 30 days, no later than 6/2/23 or the application may be denied.

Exit interview conducted and report was reviewed with the Licensee, Emal Amiri.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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