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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015701021
Report Date: 12/05/2023
Date Signed: 12/05/2023 01:57:40 PM

Document Has Been Signed on 12/05/2023 01:57 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:
12/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Simin Akrami TIME COMPLETED:
02:20 PM
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On December 5, 2023, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux conducted an announced Case Management visit for the purpose of a capacity increase. LPA Dacanay Breaux met with licensee, Simin Akrami. LPA tour the home for health and safety. Hours of operation is Monday - Sunday 6:00 am - 10:00pm.

Capacity Increase: All documents have been received for the increase of capacity application. The fire clearance for a capacity of 14 children was performed by the Fremont Fire Department on 10/20/23. The Oakland Regional Office received and processed the approved fire clearance from the Fremont Fire Department on 11/08/2023. The licensee was reminded to abide by the conditions of the fire clearance which restricts the use of the second floor to children in care (there is no attached garage). The licensee was reminded that an assistant must be present at ALL times when there is more than 8 children in attendance. Whenever the assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.

ON Limits: First floor the living room, kitchen, half bathroom (main level) and dining room.

Off-limit: Entire second floor, all three bedrooms including the master bedroom and bathroom and rear patio on the first level. Isolation area: Living room away from the children in care.

Assistant Requirements: When the licensee has an assistant, the licensee will ensure that the assistant has the following documents and placed in a personnel file for review: 1) Mandated Reporter certificate for Child Care Providers, 2) Criminal Record Clearance and associated to the facility, 3) Proof of immunization against Measles (MMR) & Pertussis (Tdap), 4) Proof of TB Clearance, & 5) Signed copy of the Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) Form. CPR & First Aide is required if the assistant is left alone with the children.

The home is recommended for an increase of capacity and will go effective today, 12/05/2023.

A notice of site visit of given was given and must be posted for 30 days. Appeal Rights Provided. Exit interview was conducted and report was reviewed with the licensee, Simin Akrami.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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