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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420410
Report Date: 11/16/2023
Date Signed: 11/16/2023 10:53:51 AM

Document Has Been Signed on 11/16/2023 10:53 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, 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: 9DATE:
11/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Masooda MiazadTIME COMPLETED:
11:10 AM
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On 11/16/2023 Licensing Program Analyst (LPA) Diana Campos arrived at the home and met with licensee Masooda Miazad for an unannounced Case Management- Licensee Initiated inspection. Present during today's inspection was licensee, her husband and 9 children in care consisting of 2 infants and 7 preschoolers. The home was toured with licensee to conduct a health and safety inspection. Hours of operation are Monday through Friday 8:00am to 6:00pm.

The lower level of home was inspected and approved by the Fire Department on 10/25/2023 for day care use. An initial inspection was conducted by LPA on 9/12/23.

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/play room, a kitchenette and a patio deck. The off limit areas include the entire upper level of the home, as well as the kitchen, dining room and patio deck on the main floor. Off limit areas on the lower level are the kitchenette, closet, and bathroom. Off limit areas are made inaccessible by use of gates, closed and/or locked doors and visual supervision. The stairs connecting the main and lower level have closed/locked doors and child proof gate at top and bottom of stairs to prevent access by children in care. 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). 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 during today's inspection.

Today the lower level of the home was inspected and approved for day care use following Fire Clearance granted on 10/25/23. On limits to day care children on the lower level are the living room/play room, the bedroom and the small patio deck which is fully enclosed with child proof gate to prevent access by children in care. The stairs connecting the main floor and lower level have locked doors and child proof gate at top and bottom of stairs to prevent access by children in care. Licensee was reminded to contact licensing office so that an inspection can be made prior to using any "off-limit" areas for day care.

Exit interview conducted and report reviewed with the licensee Masooda Miazad.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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