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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623977
Report Date: 09/03/2021
Date Signed: 09/03/2021 03:42:28 PM

Document Has Been Signed on 09/03/2021 03:42 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:ENTEZARI, SAEEDAFACILITY NUMBER:
343623977
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
09/03/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Saeeda EntezariTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with applicant, Saeeda Entezari, and a realitive, Saeed, for a scheduled pre-licensing inspection at the facility. Applicant lives in two story home with one adult and two minor children. Applicant has provided the proof of ownership of the house. Hours of operation are Monday to Friday 6:00 AM to 7:00 PM. Child care will be provided on the ground floor in Kitchen, Hall next to kitchen, Bathroom in hallway, Hall next to front entry door and Back yard. Off limit areas: Entire second floor, Garage, Bedroom next to the garage. All off limits areas must remain inaccessible to children. Isolation of an ill child will be in Hall next to the front entry door. Applicant was notified that prior to use of any off limits area, the department must be notified.

LPA Singh inspected the entire home with the applicant for health and safety hazards. The side door of the house will be used for the entrance to the day care. The house has proper temperature and ventilation. All the toxic or dangerous materials are stored in off limit areas. Drawers in the kitchen have child protective locks installed. There two a fireplaces in the house and are barricaded. Stairs are barricaded with gate. The house has a working telephone, fully charged fire extinguisher, smoke detector and carbon monoxide detector. There is first aid kit available. There is a variety of age appropriate toys available. As per the applicant, there are no firearms or weapons in the home. Per applicant, there are no pets in the house. There are no pools, spas or other bodies of water in the house.

Applicant is informed that all 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility by submitting an LIC 9182 with copy of CA DL or CA ID prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.
See next page for continuation .........................
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2021
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: ENTEZARI, SAEEDA
FACILITY NUMBER: 343623977
VISIT DATE: 09/03/2021
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LPA discuss licensing regulations and capacity requirements and a capacity worksheet was provided. Licensing forms and posting requirements were reviewed with the applicant. Applicant has submitted record of all the required immunization, CPR and Mandated reporter training certificate. Applicant understands that fire/earthquake drills are to be conducted every 6 months and recorded. Applicant understands that baby walkers, bouncers, and excersaucers are not allowed. Smoking is prohibited in family child care homes. Licensee was informed about the Provider Information Notices (PINs) on CCLD website. LPA reminded applicant that all adults providing care and supervision must be immunized against measles, pertussis and influenza. Documentation is on file. LPA informed the applicant that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Licensee has completed her training on March 31, 2018.

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

The applicant is encouraged to frequently visit website at http://www.ccld.ca.gov/ for licensing regulations and new updates. Applicant can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Prior to issue license, facility needs to complete the following:
- Mandated reporter training completion certificate.
- Obtain the criminal background clearance for the husband.

Copy of this report was reviewed and provided to applicant. This report will be kept in the facility file and will be made available for public review upon request. Desk Duty is available Monday through Friday between 8 AM - 5 PM at (916) 263-5744.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
LIC809 (FAS) - (06/04)
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