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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622440
Report Date: 07/20/2021
Date Signed: 07/20/2021 12:51:18 PM

Document Has Been Signed on 07/20/2021 12:51 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KHODAIE, AZITAFACILITY NUMBER:
313622440
ADMINISTRATOR:KHODAIE, AZITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 705-7275
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
07/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Azia KhodaieTIME COMPLETED:
01:00 PM
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On July 20th, 2021 at 10:30 am, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Azita Khodaie for an unannounced annual inspection.

At, 10:30 am LPA observed a census of six children, which included one infant and five preschool age children. Licensee’s mother and husband were present during the inspection. Licensee stated there aren’t new residents in the home. All adult residents have criminal record clearances.

LPA toured areas of the home accessible to the children. The off-limit areas of the home are: the upstairs and the living room.

LPA observed that Licensee is enrolled for CPR/First Certification renewal on July 22, 2021. Licensee will send proof of completion to LPA after completing the renewal. LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. LPA reviewed children's records for completeness, as well as the client roster. LPA observed records of immunizations for MMR, Pertussis, and influenza .

During the interior and exterior inspection:
LPA observed that hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach.
LPA observed a fireplace that was properly screened, (and stairs were properly barricaded).
LPA observed a working telephone in the home.
Licensee stated that there are no weapons in the home.
LPA observed a fire extinguisher which was last serviced on 08/10/2020. Carbon monoxide and smoke detectors were tested and observed to be functional. LPA observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months.
Equipment and furnishings in areas where children are active appeared to be safe and in working order.
LPA did not observe standing bodies of water during today’s inspection.
REPORT CONTINUED ON THE FOLLOWING PAGE.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: KHODAIE, AZITA
FACILITY NUMBER: 313622440
VISIT DATE: 07/20/2021
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Incidental Medical Services (IMS) was discussed and the licensee is not currently providing IMS. LPA discussed safety precautions and best practices for when these services are provided to children in care.

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

Current AB1207 Mandated Reporter training was not observed to be current during the inspection. Licensee stated that her training is current, but she was not able to provide proof during the inspection. LPA provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years.



LPA discussed recent changes in licensing requirements, Safe Sleep Regulations Concepts and provided licensee with Provider Information Notice. LPA also provided licensee with CDSS’ AB 2370 brochure regarding the effects of lead exposure. LPA provided the licensee with the Winter 2020 quarterly update from the Childcare Advocates program.

No deficiencies were observed during today’s inspection.



This report was reviewed with licensee, and an exit interview was conducted.

A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
LIC809 (FAS) - (06/04)
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