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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211481
Report Date: 08/17/2022
Date Signed: 08/17/2022 06:22:53 PM

Document Has Been Signed on 08/17/2022 06:22 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:F-NADIMI, MANIGEHFACILITY NUMBER:
010211481
ADMINISTRATOR:F-NADIMI, MANIGEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 887-8058
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 5DATE:
08/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:MANIGEH F-NADIMITIME COMPLETED:
04:46 PM
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Licensing Program Analyst Sidney Cortez, met with licensee Manigeh F-Nadimi for an UNANNOUNCED ANNUAL RANDOM INSPECTION. Present for this visit was the licensee Manigeh F-Nadimi. Present also 5 pre school age children. The home was toured to conduct a Health and Safety Inspection. The facility currently operates from 7:00AM until 5:30PM, MONDAY-FRIDAY. The home is a single story home, which is neat and clean with heating and ventilation for safety and comfort. The on limit areas are the garage which has been converted into the child care room, three bedrooms, two bathrooms, kitchen, dining room and living room.The off limit areas is the outdoor side storage patio area and the front yard, and kitchen which will be inaccessible by closed and/or locked gate and visual supervision at all times..The isolation area will be one of the on limit bedroom. The outdoor play area is fenced and free from defects or dangerous conditions. There are ample age appropriate toys that appear to be safe and in good condition.There are no pools, hot tubs or any other bodies of water. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. Per licensee, there are no firearms in the home. The home has a working smoke detector, carbon monoxide detector, working telephone, and First Aid Kit.The home has a fully charged (3A40BC) fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. The licensee CPR and First Aid certificate is current and expires (November 2023). The licensee's mandated reporter training is current and expires (June 2023).Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on July 15, 2022. 2 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Sidney Cortez
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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