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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101003
Report Date: 03/07/2022
Date Signed: 03/08/2022 12:11:01 PM

Document Has Been Signed on 03/08/2022 12:11 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:WAZIR, BAKHMALA & MIR AJAM KHAN, ABDALI FCCFACILITY NUMBER:
376101003
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
03/07/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Applicants BAkhmala Wazir and Abdali Mir Ajam KhanTIME COMPLETED:
12:15 PM
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LPA, Joelle Redding, met with Applicants Bakhmala Wazir and Abdali Mir Ajam Khan, for the purpose of a Pre-Licensing inspection. Application for a Change of Location was received on 1/24/22. .

LPA toured the home. It is Unit A, the first floor home with three bedrooms and two bathrooms. It is Unit A of a two unit building. Unit B will not have access to the garage, backyard or Unit A and will only share a driveway. It has it's own separate entrance. All required forms will be posted. LPA provided copies today. There is a working telephone on the premises. LPA did not note any hazardous items accessible to children. The fire extinguisher size (2A10BC or larger) meets requirements and is fully charged, located in the foyer. The smoke detector (located in the rear hallway) and carbon monoxide detector (located in the living room) are operational. Applicants Pediatric CPR/FA certification with A-B-Cpr are valid through 2/21/23. All adults living or working in the home have been fingerprint cleared and associated and immunization requirements have been met. Control of property was verified. Applicant will be using the following areas for childcare: Main living areas including front bedroom and bathroom and the fenced front yard when grass is completed. Off limits areas of the home include: rear two bedrooms and batrhroom, garage and backyard. These areas have been made inaccessible with the use of door knob covers. Bathroom and kitchen cabinets are latched. Outdoor play area will be the front yard. The landlord will be laying artificial grass and it will be fully-fenced. Age approriate toys will be used. Applicant was reminded of requirements for children’s records, child abuse reporting, unusual incident reporting, immunizations, criminal background clearance procedures and policies, posting requirements.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: WAZIR, BAKHMALA & MIR AJAM KHAN, ABDALI FCC
FACILITY NUMBER: 376101003
VISIT DATE: 03/07/2022
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an additional resource. LPA also informed licensee [facility representative] 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 is reminded that infants may not be swaddled while in care and walkers, exersaucers, jumpers, bouncy seats, napping portables and drop sided cribs are not permitted for use. Smoking during in or around day care areas is prohibited.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, an updated Plan of Operation that includes 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.They do not plan on caring for any children requiring these services for now.

Applicant was reminded that all adults 18 and over living or working in the home, 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.Applicant is to be present in the home to ensure children are supervised and reminded that no children are to be left in parked vehicles and car seats are not to use used for sleeping. Capacity limitations were reviewed and Applicant was reminded that a license is not transferable. LPA discussed California Megan's Law and the website was provided as follows: www.meganslaw.ca.gov

Licensee is advised to sign up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov. Select “Child Care” then “Quick Links” and Quarterly Updates. Select “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and select “subscribe.”

Back yard needs cleaning of debris as it would be used until the front yard is ready. Applicants will send photos to verify correction. Once photos are received and upon final file review, the change of location will be granted and a new license will be sent for posting.

SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Joelle Redding
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC809 (FAS) - (06/04)
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