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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701021
Report Date: 09/11/2023
Date Signed: 09/11/2023 02:07:09 PM

Document Has Been Signed on 09/11/2023 02:07 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:AKRAMI, SIMINFACILITY NUMBER:
015701021
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
09/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Simin AkramiTIME COMPLETED:
02:35 PM
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On 09/11/23, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an Announced Pre licensing Inspection for the purpose of a Change in Location and met with licensee, Simin Akrami. Licensee, fingerprint cleared husband, M. Akrami and two children one son and one daughter (ages 14 and 11 years) reside in the home. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was licensee, A. Simin. The facility was toured to conduct a health and safety inspection. The facility plans to operate between the hours of 6:00 AM-10:00 PM, Sunday - Saturday, ages 0- 6 years old/school age.

This two story townhouse 3 bedrooms and one and half bathroom. This home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS WHERE CHILDREN WILL NOT BE PERMITTED: the entire second level of the home which will be inaccessible by a barrier gate at the bottom of the staircase. The Isolation area will be a section of the living room, away from other children in care, until the parents pick up. LPA reviewed copy of the Grant deed showing licensee hold title to the property.

OUTDOORS: (Off limits) There are no pools, hot tubs or any other bodies of water present during todays inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

On-limit-areas are the: First floor the living room, kitchen, half bathroom and dining room.

Off-limit-areas are : Entire second floor, all three bedrooms including the master bedroom and bathroom and rear patio on the first level.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: AKRAMI, SIMIN
FACILITY NUMBER: 015701021
VISIT DATE: 09/11/2023
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For outdoor activities, the licensee states that she would take the children to the local park and the licensee is reminded to have 100% supervision at all times while away from the facility.

The home has a fully charged 3A40BC fire extinguisher located in the kitchen, working smoke detector, working carbon monoxide detector, fully stocked first aide kit and telephone. Per licensee, there are no firearms and no pets in the home. LPA reminded licensee that the parent board needs to be located at the entry for the parent to view. Licensee's CPR and First Aid certificate is current and expires 5/22/23.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee 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 is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: AKRAMI, SIMIN
FACILITY NUMBER: 015701021
VISIT DATE: 09/11/2023
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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.

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.

Licensee is reminded that children are not to be at the day care facility over 12 hours a day. Playpen is required for infants (0-24 months). LPA discussed sleep log and sleep plan and provided licensee LIC 9227 and LIC 282. Per licensee mandated reporter training is not in her preferred language Farsi.

MyChildCarePlan.org: Director 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.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

Megan’s Law: 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.

This home is recommended for Licensee/change of location on 09/11/23. Appeal Rights provided. Notice of site visit provided must remain posted for 30days. . This report shall remain on file for 3 years. Exit interview conducted with licensee, Simin Akrami.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
LIC809 (FAS) - (06/04)
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