304313656-7-21-2021-06-CC-KDEI-C55SQ8-20210721140418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313656
Report Date: 07/21/2021
Date Signed: 07/21/2021 02:04:39 PM

Document Has Been Signed on 07/21/2021 02:04 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ZEIGHAMI, PEIMANEH & BEKR, ADAM		FACILITY NUMBER:	304313656
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	07/21/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Licensee's : Zeighami,Peimaneh & Bekr, Adam		TIME COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst’s (LPA) Ketki Desai conducted an unannounced In-person Case Management. License initiated inspection for a change in capacity at the existing Family Child Care home. LPA met with Licensee's Zeighami,Peimaneh & Bekr, Adam present at the site, providing care and supervision to children while the licensee Bekr, Adam gave a tour of the home. At the time of inspection there was 2 Toddlers and 2 Preschool age children in care. A review of the Facility Personnel Report Summary indicates all adults, residing in the home who require caregiver background check clearances are cleared. There are four adults residing in the home. Licensee is requesting a Large family childcare home license. Per Licensee, operation hours will be Monday to Friday 6.30 AM to 6.30 PM. Licensee states that they will care for Infants 2 months to School age children (10) years of age. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story condo home that consists of 2 bedrooms, 1 and half restrooms, living room, kitchen with dining, laundry room, back yard and a detached garage. There is a stairway in the home and Licensee has installed a child safety gate making the second level of the home inaccessible to children. There is no Fire place in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license, she was informed if any changes are to occur, Department shall be notified. (Pg-1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZEIGHAMI, PEIMANEH & BEKR, ADAM	FACILITY NUMBER: 304313656
	VISIT DATE: 07/21/2021

NARRATIVE

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Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a central Air /Heating system. The A/C unit is in the area inaccessible to children (on the top roof of the condo home)

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock.

Based on the Facility Sketch submitted, areas off limits to children and parents are: Entire second level of the home - two bedrooms / 1 Master Bathroom / kitchen / laundry room (upstairs) and detached garage are designated as off -limits area.

Licensee has installed child safety gates on the stairway of the home leading to the second level of the home, second safety gate at the entrance of the kitchen making it inaccessible, laundry room is on the first level while garage is detached away from the condo. Licensee also has placed child safety stoppers on the refrigerator in the living area and on the closet adjoining to it. The living area has a collapsible safety gate at the entrance, making the stairway and entrance door inaccessible to the children. The home was observed to be safe for children in care.
Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA also observed COVID19, precautions at the facility, with required postings, temperature checks upon arrival, social distancing and activities being held in small groups.

Areas Designated for Day care activities: Licensee has designated living area / dining area / one half bathroom on the right hand side, in the living area for Day care children along with the Back yard. (Pg-2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZEIGHAMI, PEIMANEH & BEKR, ADAM	FACILITY NUMBER: 304313656
	VISIT DATE: 07/21/2021

NARRATIVE

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Children shall enter the home through the front entrance, they walk into the living area. These area is used mainly for activities and during napping time.

There are Play pens for Infants and mats for older children used during nap time.

Since there are two Licensee, Infants sleep in the dining area , so each licensee stays in the area where children are napping. Dining area is redesigned for Day care activities and age appropriate toys along with Arts and Crafts activities are arranged.

The bathroom designated for day care use was observed to be safe and free of hazardous items. Bathroom was clean. Cabinet below the sink has a child stopper latch making it inaccessible to children. There is also a step stool and age appropriate toilet seat with potty chair for toddlers who are receiving Toilet training.

Since the Licensee is providing Infant Care, she has appropriate Infant furniture including changing table/Play pens and high chairs.

All the infant needs are provided by the parents. (Diapers/Wipes/Formula,/ bedding linens are provided by the parents and washed by parents. Older children nap on the mats, linens and blankets are provided by the parents , stored in their individual cubbies and are taken home on a weekly basis, and are washed by the parents. Licensee does have additional linens and blankets if needed.

OUTDOOR PLAY AREA: Backyard Patio is designated for outdoor play area, it is fenced and has concrete with sufficient shade, it has age appropriate outdoor toys. There is an area with a small climbing structure for toddlers and preschool age children. The Licensee also has a small vegetable growing box , a Gardening activity which the older children engage in .

Per applicant, there are no pets or firearms, weapons or bodies of water on the premises.

(Page-3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZEIGHAMI, PEIMANEH & BEKR, ADAM	FACILITY NUMBER: 304313656
	VISIT DATE: 07/21/2021

NARRATIVE

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The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

Licensee states that she provides Breakfast/ Lunch and snacks for children in care. Food brought from the children’s homes, those containers shall be labeled with child’s name and properly stored or refrigerated. Licensee serves them home cooked meals.

Both the Licensee's have completed the required Pediatric First Aid and CPR which expires 06/17/2023. There are first aid supplies available.

Licensee was made aware of Infant care and PIN 20-24CCP was also discussed with the Licensee , a copy of the PIN was provided to the Licensee.

Licensee has a cell phone which is used for childcare, and remains on the premises during hours of operation.

The following was discussed with the applicant: ·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.

Civil Penalties will be assessed if not in compliance.
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.
·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.

·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed (Page-4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZEIGHAMI, PEIMANEH & BEKR, ADAM	FACILITY NUMBER: 304313656
	VISIT DATE: 07/21/2021

NARRATIVE

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Applicant was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, no infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

UPDATE: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee has submitted proof of immunization's.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com (Page-5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZEIGHAMI, PEIMANEH & BEKR, ADAM	FACILITY NUMBER: 304313656
	VISIT DATE: 07/21/2021

NARRATIVE

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Licensee provides Infant care and following was reviewed and new PIN released in September was shared.

A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:

English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

LPA reviewed with applicant the following safe sleep best practices:
*Always place infants on their backs for sleeping
*Use only a tight-fitting sheet on the crib or play yard mattress
*Do not hang any items from the crib or above the crib
*Keep all items, including blankets, out of the crib or play yard
*Pacifiers may be used as long as they do not have items attached to them
*Infants should not be swaddled or have any items covering them while sleeping
*The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold

(Page-6)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZEIGHAMI, PEIMANEH & BEKR, ADAM	FACILITY NUMBER: 304313656
	VISIT DATE: 07/21/2021

NARRATIVE

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Incidental Medical Services (IMS): policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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 provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)
Capacity Handout for a Large Family Child Care Home was provided.

Fire inspection from Orange County Fire Authority Fire inspection services have granted the fire clearance with specific instruction where the Second level and garage is not permitted for Day care.

The licensee does have a current roster of children in care. Facility files and three children files were reviewed and meets the requirements. Fire drills are held quarterly and records are maintained.

The facility was complying for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection. A license will be issued after final review, in the event additional requirements are needed, the Licensee will be notified.

On today’s inspection each child was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s. (Page-7)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ZEIGHAMI, PEIMANEH & BEKR, ADAM	FACILITY NUMBER: 304313656
	VISIT DATE: 07/21/2021

NARRATIVE

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An exit interview conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

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