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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420410
Report Date: 06/09/2022
Date Signed: 06/09/2022 05:25:35 PM

Document Has Been Signed on 06/09/2022 05:25 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MIAZAD, MASOODAFACILITY NUMBER:
013420410
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
06/09/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:23 PM
MET WITH:Masooda MiazadTIME COMPLETED:
05:39 PM
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On Thursday, June 9, 2022 at 2:23 PM, Licensing Program Analyst (LPA) Caroline Colson met with Masooda Miazad and her husband Naim Miazad for an unannounced increase in capacity inspection. The home was toured for a Health and Safety Inspection. Hours of Operation are Monday - Friday from 8:00 AM to 6:00 PM.

The home is a three story home. The home consist of one upstairs bedroom, one upstairs bathroom, 1 bedroom on the main level, 1 bathroom on the main level, living room, kitchen with an adjoined dinning room, 1 downstairs bedroom on the bottom level, 1 downstairs living room, 1 downstairs bathroom, 1 downstairs kitchenette, fenced side yard is on the main level and a staircase on the main level that leads to the upstairs bedroom. A section of the fenced side yard will be used for the outdoor play space. The upstairs bedroom, upstairs bathroom, kitchen, second section of the fenced side yard, staircase and entire downstairs area are the Off Limits Areas. There is 2A10BC fire extinguisher, a working smoke detector and a working carbon monoxide detector. Mrs. Miazad has heating for the home. Masooda states that there are no firearms in the home. There are toys available for the children. Her CPR and First Aid certificates are current and expire on June 30, 2023. Mandated Reporter Training Certificate expires on September 18, 2023. The isolation area will be the bedroom. There are no pets.



Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2022
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MIAZAD, MASOODA
FACILITY NUMBER: 013420410
VISIT DATE: 06/09/2022
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The following items will be need to be done before licensing the facility as a Large Family Day Care Home. Licensee will need to purchase two (2) plastic or wood registers for the vents. All Children Files will need to be completed and available for review. The fire place screen needs to be more secured. All personal products located in the bathroom need to be inaccessible to children. The kitchen gate and staircase gate needs to be more secured. All assistants needs to complete the Mandated Reporter Training and submit vaccination records.

REMINDERS/RESOURCES

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov


· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

· Licensees may register to receive child care updates: www.myccl.ca.gov

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 ADA, available at: http://www.ada.gov/childquanda.htm

Please See LIC 809 C for Additional Information
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MIAZAD, MASOODA
FACILITY NUMBER: 013420410
VISIT DATE: 06/09/2022
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Family Child Care Homes
Licensee 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.

Safe Sleep

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Masooda Miazad 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.

Notice of Site Visit

A notice of site visit was given and must remain posted for 30 days.

Exit Interview

Exit interview conducted and report was reviewed with the licensee, Masooda Miazad.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
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