015700151-7-8-2021-52-CC-JWIS-C4QTHU-20210708144520

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700151
Report Date: 07/08/2021
Date Signed: 07/08/2021 02:45:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	HASSANI, YALDA		FACILITY NUMBER:	015700151
ADMINISTRATOR:	HASSANI, YALDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 557-9723
CITY:	NEWARK	STATE: CA	ZIP CODE:	94560
CAPACITY:	14	CENSUS: 11	DATE:	07/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Yalda Hassani		TIME COMPLETED:	02:55 PM

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	On 07/08/2021 at 1:10pm, Licensing Program Analyst (LPA) Jonathan Williams met with Licensee, Yalda Hassani, for a Required 1 Year Inspection. Present for this inspection are the Licensee, one fingerprint cleared and associated assistant, and 11 children in care (three infants and eight preschoolers). The facility was toured to conduct a Health and Safety Inspection. The home is a two-story home and is tidy and clean with heating and ventilation for safety and comfort. The stairwell leading into the second floor was observed at 1:10pm to be barricaded to prevent access by children. The ON LIMIT AREAS are the kitchen, living room #2, downstairs bedroom, downstairs bathroom, play room #1, and converted garage. The OFF LIMIT AREAS are living room #1, entire backyard, and entire second floor, all of which will be made inaccessible to children by closed and/or locked doors, barricade, and visual supervision. The ISOLATION ROOM is the downstairs bedroom. LPA observed toys and learning materials in the facility. There are no pools, hot tubs, ponds, or any other bodies of water in the on-limits areas during today's inspection. Per Licensee statement at 2:05pm, the above-ground pool that used to be present in the facility has been removed from the premises. All hazardous materials and toxins were observed throughout to be made inaccessible to children during today's inspection. Per Licensee statement at 1:45pm, there are no firearms kept in the home. There is a fireplace in the home which LPA observed at 1:30pm to be screened to prevent access to children. Fully stocked first aid kit was observed to be present in the facility at 2:26pm.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HASSANI, YALDA	FACILITY NUMBER: 015700151
	VISIT DATE: 07/08/2021

NARRATIVE

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LPA observed the facility to have a fully charged 2A10BC fire extinguisher and working telephone at 1:20pm. Due to its proximity to napping children, fire/carbon monoxide detectors were not tested during this inspection. Per Licensee statement at 1:50pm, fire/carbon monoxide detectors are functional. Licensee has current CPR/1st Aid training which expires on 8/24/2021. Mandated Reporter Training for Licensee expires on 6/9/2023. Mandated Reporter trainings for assistant provider expire on 4/9/2023. The facility is in ratio today. Children's files and staff files were reviewed for proper documentation. Facility roster was obtained. LPA observed the facility to document fire/disaster drills at least once every six months.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS at this time. 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.

Licensee was reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.
Licensee was reminded that California Law requires licensed Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

There are no deficiencies cited. This report shall remain on file for 3 years. A Notice of Site Visit was provided to the Licensee. LPA reminded the Licensee to post the Notice of Site Visit where it is clearly visible inside the facility for 30 days. Appeal rights were provided to the Licensee. Exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

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