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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420410
Report Date: 09/12/2023
Date Signed: 09/12/2023 01:54:29 PM

Document Has Been Signed on 09/12/2023 01:54 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:MIAZAD, MASOODAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 849-1040
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Masooda MiazadTIME COMPLETED:
02:00 PM
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On 09/12/2023 at 09:30 AM Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Required inspection at Masooda Miazad's Family Childcare Home. LPA met with licensee and her husband who assists with day care and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family childcare home days and hours of operation are Monday to Friday 08:00 AM to 06:00 PM. Present in the home at time of inspection were licensee, her husband, 2 infants and 10 preschool age children in care.

Indoor Space: At 9:50 AM a health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is a split level structure with one bedroom, one bathroom, living room, den, kitchen, dining room and small patio deck on the main level. One bedroom, and one bathroom on the upper level. One bedroom, one bathroom, living room, kitchenette and patio deck on the lower level. The home is sanitized and orderly in compliance with Title 22 Regulations during today's inspection, with heating and ventilation for the safety and comfort of children in care.


Outdoor Space: AT 11:00 AM LPA toured the outdoor area with licensee (side yard on main level) and observed it was fenced. LPA observed there are no pools, hot tubs or other bodies of water. LPA observed children use the wooden deck area which is enclosed by a child proof gate for outdoor play time. The rest of yard is off limits and only used as walkway to access the front door.

OFF-LIMIT to day care areas are the entire upper and lower levels of the home, the small patio decks with sliding doors, the kitchen and dining room area on the main level. LPA observed these areas are inaccessible to children in care today by closed locked doors, child proof gates and visual supervision.
ON- LIMIT to day care use areas are the main floor living room, family room, bedroom, bathroom and the fenced side yard .
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2023
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: 09/12/2023
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Medicines, cleaning products, and sharp objects are stored inaccessible to children in care during today's inspection. The fireplace is screened to prevent access by children in care. Central heating vents located on floor do not become hot to the touch. The home maintains a working telephone. Licensee was reminded that smoking is not allowed in a family child care home. Licensee was reminded that baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are no pets in the home. Licensee stated there are no arms and ammunition stored in the home. There is a 3A40BC fire extinguisher, working smoke and carbon monoxide detector in the home. LPA observed the bottom of the stairs are barricaded to prevent access by children in care. Children files and Facility files were reviewed. Facility contained a Children's Roster, Licensee’s mandated reporter training expires 9/18/2023 and licensee was reminded that renewal is now required. Licensee stated her CPR and first Aid certificate is current but proof could not be made available during today's inspection.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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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: 09/12/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22.

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

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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Document Has Been Signed on 09/12/2023 01:54 PM - It Cannot Be Edited


Created By: Diana Campos On 09/12/2023 at 01:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MIAZAD, MASOODA
FACILITY NUMBER: 013420410

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that current proof of CPR/First Aid certificate could not be made avialable during today's inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2023
Plan of Correction
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Licensee will submit to licensinga copy of current CPR/First Aid certificate by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sherelle Johnson
LICENSING EVALUATOR NAME:Diana Campos
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023


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