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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409515
Report Date: 03/14/2024
Date Signed: 03/14/2024 12:34:54 PM

Document Has Been Signed on 03/14/2024 12:34 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ALIZADEH RAD, DONYAFACILITY NUMBER:
073409515
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Donya Alizadeh RadTIME COMPLETED:
12:38 PM
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On March 14, 2024 at 9:20am, Licensing Program Analysts (LPAs) Indira Loza and Janai McClain arrived at the facility for an announced prelicensing inspection. LPAs met with applicant Donya Alizadeh Rad. Living in the home are the applicant, her fingerprint cleared partner (Aydin Shatrian), and her minor daughter. The applicant plans to operate 24 hours a day 7 days a week. LPAs verified the applicant's phone number and email on record are correct.

LPAs toured the home with the applicant, to conduct a health and safety inspection. LPAs observed that it is neat and clean with heating and ventilation for the safety and comfort of children. The home is one story and consists of a living room, kitchen, dining room, three bedrooms, two bathrooms, a front yard, and a backyard

The Off Limit Areas are the first bedroom on the right, the front yard, the entire left side of the backyard where the fruit trees are, and both sides of the house. The off limits areas are made inaccessible by gate, closed and/or locked doors and visual supervision.

The On Limit Areas are the kitchen, living room, two bathrooms, two back bedrooms, and the backyard.

Isolation Area - back bedroom on the right

Inside the home the LPAs observed an ample supply of age appropriate toys, activities and equipment for children, which appeared to be safe and in good condition. LPAs did not observe any medication, bodies of water, hazardous items or poisons accessible to children during the inspection today. The applicant is reminded to monitor children when they use the water table in the backyard.

The applicant stated there are no firearms in the home. The home is equipped with a fully charged 2A10BC fire extinguisher, working smoke detector and a working carbon monoxide detector. The applicant completed the preventative health and safety training which includes 1 hour of nutrition and lead component and the CPR and First Aid training which expires on 11/5/2024. The Applicant has a current Mandated Reporter Certificate which expires on 7/5/2025.


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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ALIZADEH RAD, DONYA
FACILITY NUMBER: 073409515
VISIT DATE: 03/14/2024
NARRATIVE
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LPAs reviewed all of the forms required for the children's files, facility file, posting and other information related to Licensing and the care of children. LPAs left copies with the applicant. LPAs advised the applicant of where to obtain additional copies of the forms. LPAs reminded the applicant that the required documents must be visible for the public at all times during hours of operation. A copy of the Entrance Checklist (LIC126) was provided to the applicant.

LPAs reviewed children's personal rights and the applicant advised that she understands that children's personal rights should not be violated and no corporal punishment. LPAs reminded the applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. LPAs reviewed fire/earthquake drill information, and how to complete the drill log. LPAs demonstrated how to fill out the immunization record for children's files, discussed the applicant's responsibility to ensure the records are up to date and have discussions with parents/guardians if they are not, and advised that it does not need to be done if children are enrolled in school. LPA reminded the applicant to report any injuries requiring medical attention or unusual incidents to the Oakland Regional Child Care office. LPAs reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The applicant was encouraged to periodically review regulations, guidelines and PINS on the website www.ccld.ca.gov.

LPAs verified that the applicant, and all other adults living in the home, have a criminal record clearance and are associated to the license. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ALIZADEH RAD, DONYA
FACILITY NUMBER: 073409515
VISIT DATE: 03/14/2024
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LPAs 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-andresources/safe-sleep, as an additional resource. LPAs 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.

On March 14, 2024 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 websitehttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.



Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

LPAs reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes,
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC809 (FAS) - (06/04)
Page: 3 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ALIZADEH RAD, DONYA
FACILITY NUMBER: 073409515
VISIT DATE: 03/14/2024
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children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Before a license can be granted, the applicant must put tight fitting sheets on the three Pack n Play mattresses, secure or remove the play structure, add a gate to the stairs in the backyard, and create a parent board.

Exit interview conducted.
Report reviewed and provided to Applicant Donya Alizadeh Rad.
****************************************************** Page 4 of 4 ******
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Janai McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC809 (FAS) - (06/04)
Page: 4 of 10