073400805-1-16-2020-02-CC-ASIH-BKVULH-20200116144046

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073400805
Report Date: 01/16/2020
Date Signed: 01/16/2020 02:40:52 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	VAFAEINIA, ZAHRA & KHAVARI, ABBAS		FACILITY NUMBER:	073400805
ADMINISTRATOR:	VAFAEINIA, ZAHRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 682-2854
CITY:	CONCORD	STATE: CA	ZIP CODE:	94518
CAPACITY:	14	CENSUS: 10	DATE:	01/16/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Zahra Vafaeinia and Abbas Khavari		TIME COMPLETED:	02:50 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	Licensing Program Analysts Arminder Singh and Monica Mathur, met with licensee Zahra Vafaeinia and Abbas Khavari for an UNANNOUNCED ANNUAL RANDOM INSPECTION at 12:30PM. The home was toured for Health and Safety Inspection. Present for this inspection is licensees fingerprint clear and associated daughter, 4 infants, and 6 preschool age children (total 10). The home is a single story with an attached garage. The home consists of a family room, kitchen, living room, garage, four bedroom, three bathrooms, backyard area used for play area which has two storage sheds that are locked. The home has proper heating and ventilation for safety and comfort. The ON LIMIT AREAS are the day care room (garage converted), bathroom inside of the day care room, bedroom #1, bedroom #2, Master bedroom, family room, kitchen, dinning room, laundry room to cross from day care room to family room and backyard. The OFF LIMIT AREAS are the master bathroom, office, bathroom in the hallway, left side of the backyard which has two storage sheds, which will be inaccessible by closed and/or locked doors and visual supervision. The ISOLATION AREA will be the family room. The BACKYARD play area is fenced. There are ample age appropriate toys that appear to be safe and in good condition. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible during the inspection. There are no pools, hot tubs or any bodies of water on premises. The home has a fully charged with 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensees and their daughter's CPR and First Aid certificate is current and expires 10/20/2021. Licensee's mandatory reporter training expires on January 23, 2020. Licensee does conduct fire/earthquake drills and last was conducted on 10/16/2019. The fireplace has a safety lock to prevent access by children. Per licensee, there are no firearms in the home. Please See 809-C for continuation

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: VAFAEINIA, ZAHRA & KHAVARI, ABBAS	FACILITY NUMBER: 073400805
	VISIT DATE: 01/16/2020

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This facility is providing Incidental Medical Services - IMS at this time. LPA discussed IMS services and the requirement to create a plan of operation.

REMINDERS/RESOURCES

· Criminal Background Clearance: All assistants, volunteers, frequent adult visitors (adults are individuals 18 years of age or older) must be fingerprint cleared and associated to the facility prior to be in the presence of children in care. Failure to comply, requires an immediate civil penalty of $100 to $3000 per person, per incident.

· CCLD Complaint Hotline, 1-844-LET-US-NO (1-844-538-8766) email: LetUsNo@dss.ca.gov

· NEW LAW: Safe Sleep Regulations: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep

· Licensees and all staff are Mandated Reporters and are required to report to CCLD any suspected child abuse.

CCLD website address for obtaining licensing forms, training videos and other provider resources can be obtained at www.ccld.ca.gov

Day and hours of operation is Monday-Friday 7AM- 6PM

LPA's advised licensee to submit an updated:
- family home sketch (show bathroom in garage (in use), mention master bathroom (off limit)
-send photos of locked walk-in closet in master bedroom
- application LIC 279 (updated names of adults living in home)
- IMS Plan of operation

In today's inspection no deficiencies were cited. A notice of site visit was issued which shall remain posted for 30 consecutive days near the front entrance of home.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

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