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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 01:51:50 PM

Document Has Been Signed on 09/12/2023 01:51 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: 12DATE:
09/12/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mazooda MiazadTIME COMPLETED:
02:00 PM
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On 09/18/2023, Licensing Program Analyst (LPA), Diana Campos conducted a case management inspection (licensee initiated) for the purpose of adding additional areas of the home to the On-Limit areas of day care. Present during today's inspection were the licensee, her husband and 12 children in care consisting of 2 infants and 10 preschoolers. The on limit areas of home was toured to conduct a health and safety inspection with the licensee. Hours of operation for day care are Monday through Friday 8:00am to 6:00pm.

The home is a split level 3 story home which is neat and clean with heating and ventilation for the safety and comfort of the children. The main level consists of the living room, den, dining room, kitchen, one bedroom, bathroom, and a small patio deck. The upper level consists of one bedroom and one bathroom. The lower level consists of one bedroom, one bathroom, a living room, a kitchenette and a patio deck. The off limit areas include the entire upper and lower levels of the home, as well as the kitchen, dining room and patio deck on the main floor. Off limit areas are made inaccessible by use of gates, closed and/or locked doors and visual supervision. The on limits areas are the living room, family room, bedroom, bathroom and enclosed deck in the side yard (all on the main level of home). All areas were inspected by LPA to conduct a health and safety inspection. The isolation area will be the bedroom on the main level. Per licensee, there are no firearms or pets in the home. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. The home has a fully charged 3A40BC fire extinguisher, working smoke detector and carbon monoxide, telephone, and fully stocked first aid kit.

See 809-C for continuance.------------------------------------------------------------------------------
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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Licensee's Mandated Reporter training certificate is current and expires 9/18/2023. Preventative Health and Safety training with Lead poisoning training was completed by Licensee. Licensee is in compliance with immunization requirements.

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

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.

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-and-resources/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.

No deficiencies observed at this visit.

Licensee has requested to add the lower level of home as part of the on-limit areas of day care.


Pending a review of the current fire clearance, the following items must be completed before a decision can be made to add the lower level of home to the on-limit day care use areas:

-Stair case to access lower level from inside home must be reopened and in safe condition for children's use.

-bottom and top of connecting stair case must be barricaded by a secured child proof gate to prevent a hazard by children in care.

-patio deck outside sliding doors must have a mesh surrounding the 3 inch gap at bottom of fence to prevent a hazard by children in care as well as a child proof gate at top of stairs.

A notice of site visit was given and must remain posted for 30 days. 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
LIC809 (FAS) - (06/04)
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