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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624230
Report Date: 05/16/2022
Date Signed: 05/16/2022 09:47:33 AM

Document Has Been Signed on 05/16/2022 09:47 AM - 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:HASSANZADAH, SOODABAHFACILITY NUMBER:
343624230
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
05/16/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Soodabah HassanzadahTIME COMPLETED:
09:50 AM
NARRATIVE
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On Thursday, May 16, 2022 at 9:00 AM, Licensing Program Analysts (LPA) Amanda Sutter and Licensing Program Manager (LPM) Seychelle De Luca met with Applicant Soodabah Hassanzadah for the purpose of an announced change of location pre-licensing inspection. Applicant was previously licensed under facility #343623910. During today’s visit, the applicant’s husband was in the home. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday through Friday from 6:30 AM to 11:00 PM.

A health and safety inspection was conducted inside and outside the home. The facility is a single story home which includes 3 bedrooms, 1 bathroom, kitchen, and a living room. There is a building (building B) disconnected from the home that has two kitchen areas. Off-limit areas will include: bedrooms 1 and 2, kitchen, and building B. Applicant understands that children may never enter these off-limit areas.

Toxic and hazardous items are inaccessible to children and out of children’s reach. LPA advised the applicant that if there are ever any poisons at the home, all poisons must be locked with a key lock or combination lock. Sharp knives and children medication are stored in a kitchen cabinet above the refrigerator out of children’s reach. A functioning smoke detector, carbon monoxide detector, and 2A10BC fire extinguisher were observed. Applicant stated that there are no weapons in the home. There is an unbarricaded fireplace in the backyard. There is an unbarricaded fountain in the backyard. LPAs discussed all required licensing postings.

Applicant has completed the required Preventative Health and Safety course with the Lead Poisoning Prevention training. Current EMSA approved pediatric CPR/First Aid training was verified and expires 2/6/23. Current Mandated Reporter training due was verified and expires 2/17/23.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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 3
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: HASSANZADAH, SOODABAH
FACILITY NUMBER: 343624230
VISIT DATE: 05/16/2022
NARRATIVE
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Applicant Soodabah Hassanzadah was encouraged to maintain supervision at all times. Applicant understands that if an unusual incident occurs, licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. LPA discussed Type A/B citations, open door policy, fire drills, children’s personal rights with the applicant. A current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer in care.

LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected. Applicant understands that if any structural changes are made to the home, licensing must be notified prior to construction. Applicant understands that if she want to make any off-limit area an on-limits area, licensing must be notified and LPA must do an inspection before children are allowed in the area. Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA reviewed with applicant the LIC 311D (Forms/Records To Keep In Your Family Child Care Homes), children’s forms/records, facility forms/records, and information to be posted.

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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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 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-and-resources/safe-sleep as an additional resource. LPAs also informed Director 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. PAGE 2. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: HASSANZADAH, SOODABAH
FACILITY NUMBER: 343624230
VISIT DATE: 05/16/2022
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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 platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following items must be corrected prior to licensure:

1. LPA Sutter will return to inspect the barricaded fountain.

2. Applicant will submit proof the fire place in the backyard is properly barricaded.

3. The debris and waste in the backyard will be removed.

Exit interview conducted and report was reviewed with the applicant Soodabah Hassanzadah

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC809 (FAS) - (06/04)
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