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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100360
Report Date: 08/20/2021
Date Signed: 08/20/2021 09:37:28 AM

Document Has Been Signed on 08/20/2021 09:37 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:DIZAYI, ROZHAN FAMILY CHILD CAREFACILITY NUMBER:
376100360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Rozhan DizayiTIME COMPLETED:
10:30 AM
NARRATIVE
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On 8/20/21 @ 8:33AM, LPA Nancy Diaz conducted an unannounced inspection. LPA met with Rozhan Dizayi. There were no children observed present today. Mrs. Dizayi stated that she has not provided care since she was licensed in 2020. A tour of the home was conducted. The following areas are accessible to children - living room, daughter's bedroom, kitchen, dining room, hallway bathroom and back fenced yard. Off-limit areas are: garage, master & son's bedroom.

A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.
There is an above ground pool (3 ft. high) located in the yard. This above ground pool was observed to be uncovered and accessible to children. Included in today's discussion are the following option: Cover - the cover shall support the weight of an adult. Fence - Fences shall be at least five feet high and shall be constructed so that the fence does not obscure the pool from view. Fence shall have a self-latching gate and must also include the living room windows that opens to the yard.

Mrs. Dizayi stated that she does not maintain any weapon/firearm in the home.

The outdoor play area is fenced or supervised by the licensee. An isolation area has been designated for children who became ill during the day.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: DIZAYI, ROZHAN FAMILY CHILD CARE
FACILITY NUMBER: 376100360
VISIT DATE: 08/20/2021
NARRATIVE
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Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored appropriately and inaccessible to children.
Fire extinguisher and smoke detectors meet State Fire Marshall standards. The carbon monoxide detector present in the home meet the standards established in Chapter 8 of Part 2, Division 12. Home is kept clean and orderly with heating and ventilation for safety and comfort. Licensee provide safe toys, play equipment and materials. The home maintains a working telephone service.

Staff records were reviewed. Mrs. Dizayi is exempt from the mandated reporter training requirement. Her primary language is Arabic/Kurdish.
Mrs. Dizayi have been immunized against influenza, pertussis and measles. Licensee’s CPR and First aid is valid thru February 2022.

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

Type A deficiency was cited today. Type A deficiency if not corrected poses an immediate risk to the health and safety of children in care.
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Exit interview was conducted with Mrs. Dizayi. Appeal rights were provided with a copy of the site inspection. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
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Document Has Been Signed on 08/20/2021 09:37 AM - It Cannot Be Edited


Created By: Nancy Diaz On 08/20/2021 at 09:11 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DIZAYI, ROZHAN FAMILY CHILD CARE
FACILITY NUMBER: 376100360

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/27/2021
Section Cited
CCR
102417(g)(5)

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OPERATION OF A FAMILY CHILD CARE HOME. All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
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Mrs. Dizayi stated that her husband is due to return the week of 8/23/21. She will notify this analyst regarding her plan of action as soon as she speaks with her husband. She is considering her options of: covering, install a fence around or just remove the pool.
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This regulation was not met as evidenced by: Based on LPA's observation, Mrs. Dizayi installed a 3 ft. above ground pool that is not covered or fenced in. Having an unfenced or uncovered body of water poses an immediate risk to the health, safety or personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2021


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