Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372015741
Report Date: 04/12/2018
Date Signed 04/12/2018 01:11:41 PM

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:RAJPUT, IRFANA FAMILY CHILD CAREFACILITY NUMBER:
372015741
ADMINISTRATOR:IRFANA RAJPUTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 484-7621
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY:14CENSUS: 10DATE:
04/12/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Irfana RajputTIME COMPLETED:
01:20 PM
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LPA Monica Cuddy conducted an unannounced inspection with the Licensee. The 2 story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present were the Licensee, Licensee's husband, a helper, and 10 day care children. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aid and CPR certifications for licensee, husband and helper expire on 12/18. Children’s records have up to date immunization records, and Notification of Parent’s Rights Receipts. Licensee maintains a current roster and is conducting emergency/disaster drills according to regulation.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include the entire downstairs area. Off limits areas include laundry room, garage, and upstairs area. The licensee has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. The staircase is barricaded and the fireplace is screened.

Provider is hereby reminded of the following: maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances to avoid civil penalties associated with this requirement; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. Licensee was also provided with information regarding SIDS and Shaken Baby Syndrome. Staff immunization requirements were met. Licensee and staff will complete mandated reporter training as soon as possible.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Monica CuddyTELEPHONE: 619-767-2249
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2018
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: RAJPUT, IRFANA FAMILY CHILD CARE
FACILITY NUMBER: 372015741
VISIT DATE: 04/12/2018
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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, 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.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. LPA provided notice of site visit and observed it being posted at the facility.
No Deficiencies are cited.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Monica CuddyTELEPHONE: 619-767-2249
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2018
LIC809 (FAS) - (06/04)
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