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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423910
Report Date: 12/18/2023
Date Signed: 12/18/2023 12:17:07 PM

Document Has Been Signed on 12/18/2023 12:17 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:YAZDANNEZHAD, ZHALEHFACILITY NUMBER:
013423910
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/18/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Zhaleh YazdannezhadTIME COMPLETED:
12:20 PM
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On 12/18/23, 10:15AM, Licensing Program Analyst (LPA) Catherine Fernandes arrived announced on a prelicensing inspection and met with applicant Zhaleh Yazdannezhad. Residing in the home is the applicant and her finger print cleared husband. The home was toured to conduct a health and safety inspection. The applicant plans to operate between the hours of 8:00AM -5:30PM, Monday -Friday.

The home is a two story house that consists of three bedrooms, and two bathrooms, which is neat and clean with heating and ventilation for safety and comfort of the children. The entrance to the child care will be the side door on Cornell street. The home does have central heating in the living room. LPA observed age appropriate toys that appear to be safe, clean and in good repair. There are no bodies of water or pools accessible to children during today’s inspection. LPA did not observe any hazardous materials or toxins, or medications accessible to children during today’s inspection. Per Applicant, there are no firearms or pets in the home. During today's inspection LPA Fernandes observed the following, cabinets in the bathroom have safety latches, the kitchen and both upstairs and downstairs stairs have safety gates.
On-limit-areas are the: The converted family room which is the main area of the day care, the dining room which will be used as a walked through space, the downstairs bedroom and bathroom and the upstairs bedroom on the left side of the hallway.
Off-limit-areas are: The kitchen, the upstairs bathroom, the garage, the backyard, the upstairs bedroom on the right side, and the living room, which will be made inaccessible by closed and/or locked doors and visual supervision.
The outdoor play: Will be the local park, LPA reminded the applicant that while outdoors 100 percent supervision is required at all times.
The Isolation area will be the lower bedroom, away from other children in care.

See 809-C

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
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: YAZDANNEZHAD, ZHALEH
FACILITY NUMBER: 013423910
VISIT DATE: 12/18/2023
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There is a fully charged 2A10BC fire extinguisher in the kitchen, a working smoke detector located in the lower bedroom and the home has a working telephone.
The applicant has a current CPR certificate that expires on 6/2025. The Applicant was reminded of the responsibility as a mandated reporter and applicant has provided proof of the required training which was conducted on 8/10/23. The applicant is in compliance with the immunization laws which pertains to all childcare providers. A copy of the rental agreement was received and shows control of property.

This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

LPA informed the applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The applicant was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was provided information regarding effects of Lead Exposure.


LPA discussed the safe sleep regulations with applicant 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 applicant 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.

See 809-C

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
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: YAZDANNEZHAD, ZHALEH
FACILITY NUMBER: 013423910
VISIT DATE: 12/18/2023
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Applicant 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.

The applicant, has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 children.

On this date, 12/18/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Before the home can be licensed the following needs to be completed:

- The drop down cribs need to be removed


- The home needs a carbon monoxide detector
- A parent board needs the car seat laws posted
- Landlord consent needs to be filled out
- Updated LIC610 needs to be filled out and mailed
Exit interview conducted and report was reviewed with the applicant Matin. Report provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
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