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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624177
Report Date: 04/19/2022
Date Signed: 04/19/2022 10:19:29 AM

Document Has Been Signed on 04/19/2022 10:19 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SAFI, JAMILAFACILITY NUMBER:
343624177
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
04/19/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Jamila SafiTIME COMPLETED:
10:30 AM
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On April 19, 2022 at approximately 9:10 AM Licensing Program Analysts (LPAs) Josiah Gathing and Alize Tillery met with Licensee Jamila Safi and Licensee’s husband. Licensee applied for a capacity increase from 8 to 14 children in care. Today’s inspection was conducted in order to inspect the house and discuss requirements for a large license. Applicant’s first language is Pashto and her husband provided translation during the inspection. The purpose of the inspection was explained.

A health and safety inspection was conducted inside and out of the home. The one-story facility includes 3 bedrooms, 2 bathrooms, kitchen, living room, family room, garage, an unfenced front yard and fenced backyard. The Off-limits areas include: bedroom #2, bathroom #2, kitchen, and garage. Licensee acknowledged that children may never enter these off-limit areas.

The fireplace is covered with a gate. Toxic and hazardous items are inaccessible to children and out of children's reach. Sharp knives are stored in the kitchen out of children's reach. Licensee will have medications stored in the kitchen, out of children’s reach. A first aid kit was observed in the home. LPAs observed all required licensing postings near the facility entrance.

During the inspection, LPAs observed the home has multiple smoke alarms and fire extinguishers. There is a carbon monoxide detector, and pull alarm. The house was inspected by local fire marshal and the clearance was granted on April 5, 2022. During the inspection LPAs informed licensee of the ratio and capacity requirements of large family home license. Licensee stated that she understands the requirements.

Cont. on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: SAFI, JAMILA
FACILITY NUMBER: 343624177
VISIT DATE: 04/19/2022
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In the areas that were evaluated, no deficiencies were observed at the time of the inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed and provided to the Licensee, Jamila Safi.

Capacity increase is approved as of today, April 19, 2022. The facility is licensed to serve a MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
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