<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500677
Report Date: 09/10/2024
Date Signed: 09/10/2024 12:34:56 PM

Document Has Been Signed on 09/10/2024 12:34 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NASIRI, JAMILAFACILITY NUMBER:
394500677
ADMINISTRATOR/
DIRECTOR:		JAMILA NASIRIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 305-6122
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
09/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Jamila NasiriTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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 09/10/2024 at 10:40 AM, Licensing Program Analyst (LPA) Janie Davis met with Licensee Jamila Nasiri with translation assistance from her adult daughter Laila Nasiri, for the purpose of an unannounced annual inspection. Licensee guided LPA on a tour of the home. (Licensee’s primary language is Pashto). LPA observed three children present in the home with Licensee and her assistant/adult child. Licensee's operating hours are Monday through Sunday and operate on a 23 1/2 hour schedule. LPA verified that annual fees are current.

All individuals subject to a criminal record review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, 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 five 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.

A health and safety inspection of the home’s interior and exterior was conducted in all areas accessible to children. The off-limits areas in the home include the entire second floor and garage. LPA observed stairs to the second floor barricaded by a baby gate. LPA observed the required postings and a working phone. LPA observed a 2A10BC fire extinguisher that meets regulations and verified both smoke and carbon monoxide detectors were functional. LPA toured the kitchen area and verified knives were inaccessible to children in care. LPA observed a restroom and verified that toxic and hazardous items were inaccessible to children in care. LPA observed cleaners stored in laundry room and inaccessible to children in care. LPA observed the living room with age-appropriate toys for children.

Continues on 809-C

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Janie Davis
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: NASIRI, JAMILA
FACILITY NUMBER: 394500677
VISIT DATE: 09/10/2024
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
26
27
28
29
30
31
32
Continued from 809

Licensee stated there are no weapons in the home. LPA observed a fireplace that was barricaded by furniture. The outdoor play area was inspected and is surrounded by a wooden fence. LPA walked the perimeter of the outdoor play area during inspection and verified that the entire area is fenced in. LPA did not observe bodies of water on the premises.

LPA reviewed children's files, with emergency information and immunization records on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. LPA verified Licensee's immunization records were available in the facility file. Current Mandated Reporter Training certificate was verified and expires on 08/23/2026. Current EMSA pediatric CPR and first aid certification was verified and expires on 07/13/2026.

LPA discussed the safe sleep regulations with Licensee, 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. LPA 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. LPA observed a single 15-minute napping log for an infant under 24 months and a copy of the Individual Sleeping Plan (LIC 9227) for infants under 12 months during the inspection. Licensee was reminded to retain documents for 3 years.

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 https://www.ada.gov/resources/child-care-centers/.

Continued on 809-C

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Janie Davis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: NASIRI, JAMILA
FACILITY NUMBER: 394500677
VISIT DATE: 09/10/2024
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
26
27
28
29
30
31
32
To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee 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.

An exit interview was conducted and report was reviewed with the licensee, Jamila Nasiri. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Janie Davis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3