<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416741
Report Date: 09/29/2021
Date Signed: 09/29/2021 10:59:46 AM

Document Has Been Signed on 09/29/2021 10:59 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:AKBARI, BRUNAFACILITY NUMBER:
434416741
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/29/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Bruna Akbari, ApplicantTIME COMPLETED:
11:10 AM
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 (LPA) James Santos met with applicant, Bruna Akbari and conducted a pre-licensing inspection. Besides the applicant, her husband is the other adult living in the home. Applicant currently does not carry liability insurance and she will have parent/authorized representative sign the Affidavit Regarding Liability Insurance for FCCH form (LIC 282). The days and hours of operation will be Monday to Friday from 8:00 am to 5:00 pm.

LPA inspected the entire home, off limit areas are: 2 bedrooms, 1 bathroom (located in master bedroom) living room area, kitchen and dining area and garage. There is a locked gate preventing children from entering the off limit areas. Off limit area outside in the backyard is the side yard/walkway located on the right side. Applicant has a pet dog and a fish aquarium. Applicant stated there are no firearms or weapons in the home. The home has smoke and carbon monoxide detectors and fire extinguisher (2A10BC).

There were sufficient age appropriated toys in the play area inside the home and in the backyard. All cleaning products, hazardous and sharp objects are inaccessible to children. Discipline policy was discussed and she understood that the children's personal rights should not be violated and corporal punishment is not allowed. Applicant will use redirection as form of discipline. Applicant stated she is not planning on transporting children but she understood the safety seat belt/car seat requirements.

Preventative Health and Safety training was completed 8/15/2021. Applicant's CPR and First Aid expires on 8/7/2023 and (AB1207) Child Care Abuse Mandated Reporter Training expires on 2/10/2022.

Report continued on the following page.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: AKBARI, BRUNA
FACILITY NUMBER: 434416741
VISIT DATE: 09/29/2021
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
26
27
28
29
30
31
32
Licensee was advised on the regulations that smoking, baby walkers, bouncers, excersaucers and other similar items are not allowed. The following was discussed, isolation of sick children; supervision of children; capacity options; requirements for reporting suspected child abuse; unusual incident/injuries; fire drills practiced at least twice a year and documented.

LPA also discussed the requirements of AB 633 to applicant and provided applicant the fact sheet and a copy of Acknowledgement of receipt of Licensing Reports (LIC 9224). Zero Tolerance with $500 civil penalty also explained to applicant.

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 Department's website: www.ccld.ca.gov to obtain forms and Title 22 regulations



LPA reminded applicant of the $100 civil penalty per person per day, a maximum of $500 per person (if cited again within 12 months maximum of $3,000 per person) for those adults who have not received fingerprint clearances, are not associated to the license that come in contact with or provide care and supervision to the children.

A review of records during today's inspection indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA provided applicant with a family child care packet.

Licensure of a small (capacity 8) family child care home license will be approved upon management's approval.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2