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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394501152
Report Date: 01/06/2025
Date Signed: 01/06/2025 11:53:02 AM

Document Has Been Signed on 01/06/2025 11:53 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KHAN, FAIZA & MUNIBFACILITY NUMBER:
394501152
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:16 AM
MET WITH:Faiza Khan and Munib KhanTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA) Erwin Tjhia met with Licensee, Faiza Khan and Munib Khan for the purpose of a case management inspection. Licensee has applied to change from a Small Family Child Care Home to a Large Family Child Care Home. There was no children present at the time of inspection. Fire clearance was granted by Lodi Fire Department on 12/18/2024.

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 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.


Because the licensees rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149)..

A health and safety inspection was conducted inside and out. The one story home has 2 bedrooms and 2 bathrooms. During today inspection licensee requested to add guest bedroom to the on limit area. LPA tour area and observe no hazardous items accessible for the children. On 01/06/2025 LPA will approve this area to be on limit area. The off-limits area in the home are the master bedroom, garage, both side yards, hall way by the master bedroom, restroom next to the master bedroom, and pantry. Outdoor play area was toured. There are no bodies of water on the premises. LPA toured the bedrooms and verified toxic and hazardous items were inaccessible to children in care. Off-limits areas will remain inaccessible to children by doorknob covers, baby gates, and baby latches.


Report Continue on 809-C
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KHAN, FAIZA & MUNIB
FACILITY NUMBER: 394501152
VISIT DATE: 01/06/2025
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Functioning smoke and carbon monoxide detectors were observed in the hallway. LPA observed cleaners stored in laundry on a shelf inaccessible to children in care. There is no fireplace in the home. 2A10BC fire extinguisher and first aid kit were observed in the kitchen. Applicant stated there are no weapons in the home.

Current in-person EMSA pediatric CPR and First Aid certification was verified and Child Care Provider Mandated Reporter certification was verified. The CPR will expire 12/2026 and the Mandated reporter will expire on 11/2026.

In addition, LPA discussed the infant sleep regulations with licensee. LPA discussed the requirement to check and log infant napping every 15 minutes for infants 24 months and under. LPA provided a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months, for licensee during today's inspection. 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.

Licensee was informed of the MyChildCarePlan.org website; 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.

Exit interview conducted and report was reviewed with the licensee, Sadeequllah Khogyani. A Notice of Site Visit was given and must remain posted for 30 days for parental review. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Effective today 01/06/2025, facility is approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without assistant, the ratios revert to those for small family childcare home.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC809 (FAS) - (06/04)
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