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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574501097
Report Date: 03/29/2024
Date Signed: 03/29/2024 09:49:15 AM

Document Has Been Signed on 03/29/2024 09:49 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KARIMI, ROUYAFACILITY NUMBER:
574501097
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
03/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:applicant, Rouya KarimiTIME COMPLETED:
10:00 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 03/29/2024 at 9:00 AM, Licensing Program Analyst (LPA) Lauren Scott met with Applicant, Rouya Karimi for the purpose of conducting a change of location inspection. Applicant is requesting a change of location from previous facility (#574500874) to current location. Applicant's tentative operating hours are Monday through Friday from 8:00 AM to 9:00 PM.

The facility is a one story home that consists of 2 bedrooms and 2 bathrooms. LPA and Licensee toured the entire home inside and outside. Off limit areas include the master bedroom and laundry room. Licensee acknowledged that children are never allowed in the off limit areas. Off limit areas will remain inaccessible by door handle covers and closed/ locked doors. Licensee understands that if any structural changes are made to the home; licensing must be notified prior to construction. Licensee understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area. Backyard is not fenced. Licensee understands that 100% supervision is required when children play in any unfenced areas.

Fire extinguisher and first aid kit is located in the hall closet. Smoke alarm/ carbon monoxide dual detector was observed to be in operational order. Licensee stated there are no weapons in the home. There are no bodies of water on the property. Hazardous items and personal hygiene items are made inaccessible to children. Sharp utensils are stored out of reach of children. Licensee has a current Mandated Reporter Training Certificate that expires 3/2025. Current pediatric CPR and first aid training was verified and expires 2/2025. LPA discussed new safe sleep regulations.

Continue 809-C

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KARIMI, ROUYA
FACILITY NUMBER: 574501097
VISIT DATE: 03/29/2024
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
Licensee currently does not have any children enrolled that require IMS. LPA discussed IMS services and the requirement to create a plan of operation. 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.

Licensee understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Licensee understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Licensee 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. Licensee understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to three years.

This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Licensee was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Effective today 03/29/24, facility is approved for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2