304313556-12-8-2021-06-CC-KDEI-BTST8W-20200925143100

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313556
Report Date: 09/24/2020
Date Signed: 12/08/2021 09:35:18 AM

Document Has Been Signed on 12/08/2021 09:35 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	YAZDANI, SARA NAZ		FACILITY NUMBER:	304313556
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	09/24/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Licensee Yazdani Sara Naz		TIME COMPLETED:	12:32 PM

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	Licensing Program Analyst (LPA) Ketki Desai conducted an announced Virtual pre-Licensing inspection (Face time) for a change in capacity at the existing Small Family Child Care home. LPA met with Licensee Yazdani Sara Naz, who guided analyst on a tour of the home. Per Licensee, family members residing in the home including the applicant are three more adults with two minor children. A review of the Facility Personnel Report Summary dated (09/23/20) indicates all adults, residing in the home who require caregiver background check clearances exemptions. Licensee is requesting a Large family childcare home license. She has been a provider since March 2019. Per Licensee, operation hours will be Monday to Friday, 7.30 AM to 5:00PM, care and supervision shall be provided to children ages Infant to school age. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story home that consists of 5 bedrooms, 3 and half restrooms, living room, kitchen, dining area, backyard, front yard and a garage. There is a stairway in the home which is made inaccessible to children by installing a safe divider.

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YAZDANI, SARA NAZ	FACILITY NUMBER: 304313556
	VISIT DATE: 09/24/2020

NARRATIVE

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Infant Care: Applicant states that she will care for infants. LPA advised the Applicant to sleep infants where they can always be directly supervised and advised against sleeping infants in a separate room. The Applicant states the following as a supervision plan for infants: The infants will sleep in the designated infant room where she will be providing supervision and they shall not be left unattended. LPA provided a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with applicant the following safe sleep best practices:
Always place infants on their backs for sleeping
Use only a tight-fitting sheet on the crib or play yard mattress
Always keep the infants on their backs
Do not hang any items from the crib or above the crib
Keep all items, including blankets, out of the crib or play yard
Pacifiers may be used as long as they do not have items attached to them
Infants should not be swaddled or have any items covering them while sleeping
he temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

Incidental Medical Services (IMS): 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

OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)

 Handouts provided for Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices
 Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YAZDANI, SARA NAZ	FACILITY NUMBER: 304313556
	VISIT DATE: 09/24/2020

NARRATIVE

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·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
Applicant was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. [email protected]

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

UPDATE: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
The licensee has submitted proof of immunizations.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YAZDANI, SARA NAZ	FACILITY NUMBER: 304313556
	VISIT DATE: 09/24/2020

NARRATIVE

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Orange County Fire authority have granted the fire clearance (9/17/20) with specific instructions : Garage and second level are not approved for Child care.

The facility was in compliance for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection. A license will be issued after final review, in the event additional requirements are needed, the applicant will be notified.

The report was read and emailed to the Licensee, (Yazdani, Sara Naz) and the read receipt shall serve in lieu of the signature.

Exit interview conducted via face time with the Licensee, Yazdani Sara Naz, who agreed with the same.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YAZDANI, SARA NAZ	FACILITY NUMBER: 304313556
	VISIT DATE: 09/24/2020

NARRATIVE

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LPA have provided the new PIN (20-24-CCP) Safe sleep regulation released on September 15^th 2020, also discussed that the younger infants need to be checked every 15 minutes and document their condition to check for any distress, including their breathing pattern, skin color, body temperature and restlessness.

Licensee provides daily breakfast/ Lunch and snacks to enrolled children and has been associated to a food program based in San Diego. Water is provided by Licensee; it is filled in their individual sports water bottles are kept on the kitchen counter for easy access.

OUTDOOR PLAY AREA: The children shall use the backyard for outdoor activities, it is completely fenced with turf and concrete flooring. Age appropriate play structure and other outdoor play equipment’s were observed, there is enough shade in the backyard. The backyard is accessed through the glass door next to the kitchen. No hazards were observed.

Per applicant, there are no, pets, firearms, weapons or bodies of water on the premises.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

Applicants have completed the required Health and Safety with Nutrition and Lead Poisoning component Training and Pediatric First Aid and CPR which expires on 7/2021. There are first aid supplies available.

The following was discussed with the applicant:
·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.

Civil Penalties will be assessed if not in compliance.

·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: YAZDANI, SARA NAZ	FACILITY NUMBER: 304313556
	VISIT DATE: 09/24/2020

NARRATIVE

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Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a central Air /Heating system, the A/C unit is installed in the corner of the side yard inaccessible to children. There are two fireplaces in the home, one in the living area (Inaccessible to children) and one in the Day care area, which is made inaccessible by a child safety lock on the glass door.
Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. Licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock. Laundry room is inaccessible to children.
Based on the Facility Sketch submitted, areas off limits to children and parents are: Entire second level of the home, (4 bedroom and two bathrooms) living area, garage, laundry room and the side yards on the first lever are made inaccessible to parents and children. One side yard with A/C unit is inaccessible while second side yard has a concrete flooring walkway leading to the front yard. The living area has a collapsible divider diving the room into two sections, making the living area completely inaccessible to children and parent. The other half side is the designated childcare area. Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Children shall enter the home through the main door of the home from the front yard, they shall walk through the walkaway area into the designated day care area, the other side of the living area. Bedroom on the first level is also designated as a Day care area where younger infants nap in the cribs. The bathroom designated to Day care area is inside this bedroom on the first level. The designated Day care area and bedroom were observed to have age appropriate toys and educational items for the children. The bathroom was observed to be safe and free of hazardous items. There is a cabinet under the sink with a child safety lock. No hazardous items were observed, and bathroom was clean. Kitchen is accessible to children, all the cabinets are clear of any hazardous items, all sharp knives are stored in the top cabinet. Kitchen sink is mainly used for washing hands by the children and a step stool is placed for easy access. No chemicals or cleaning supplies were observed.

Designated day care area is open and spacious, younger infants shall use a crib for napping while older infants and preschoolers shall nap in the day care area, cots are being used, linens are provided by the Licensee while blankets are brought from home. All the linens and blankets re washed by the Licensee on a weekly basis or as needed.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

LIC809 (FAS) - (06/04)

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