073402503-7-26-2021-02-CC-LDYN-C5AUA7-20210726152417

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402503
Report Date: 07/26/2021
Date Signed: 07/26/2021 03:24:22 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:	ZADEH, MAMAK		FACILITY NUMBER:	073402503
ADMINISTRATOR:	ZADEH, MAMAK		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 827-1805
CITY:	PACHECO	STATE: CA	ZIP CODE:	94553
CAPACITY:	14	CENSUS: 14	DATE:	07/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Mamak Zadeh		TIME COMPLETED:	03:35 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 7/26/21 at 1:05pm, Licensing Program Manager (LPM) Loretta Dyson arrived at the home for an unannounced required inspection. LPM met with the licensee. The licensee's mother/assistant was also present and caring for children. There were 2 infants, 10 preschoolers and 2 school age children also present. LPM toured all of the areas of the home used for the child care, with the licensee, including the living room, dining room, family room, kitchen, converted garage, downstairs bathroom and backyard, to conduct a health and safety inspection. The home is neat and clean with sufficient heating and ventilation for safety and comfort. The home is a two story home and the entire second level is off limits to children in care. This area is made inaccessible by a closed gate at the bottom of the stairs. The family room is used to isolate children that are sick, away from other children in care. The licensee advised that she encourages parents to keep sick children at home and contacts parents to pick up children right away if they are not feeling well. LPM observed an ample supply of age appropriate toys, activities, and furniture and they appear to be safe and in good condition. The fireplace in the family room has a glass enclosure and is blocked by furniture, to prevent access by children. The backyard is fully fenced and is used for outdoor play. LPM did not observe any toxins, hazardous items, cleaning supplies, medications or bodies of water that are accessible to children in care today. LPM did not observe any infants swaddled. LPM did not observe any child left in a parked vehicle. The licensee stated that there are no firearms in the home. The licensee and another assistant have current CPR/First Aid certificates which expire on 7/11/22. The licensee conducts and documents fire and disaster drills, at least once every 6 months, and the last earthquake/fire drill conducted was on 3/29/21. The home has a fully charged 2A10BC fire extinguisher, smoke detector, carbon monoxide detector, first aid kit and telephone. LPM observed all required postings including posters related to COVID-19 prevention measures.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ZADEH, MAMAK	FACILITY NUMBER: 073402503
	VISIT DATE: 07/26/2021

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The licensee stated that she is not currently providing transportation, but may when school begins again. The licensee verified that she is aware of the regulations related to transportation of children in care and will ensure that she and any assistants are following them.

At 1:30pm, LPM began review of children and staff files. LPM verified that children's files have completed emergency information cards. LPM verified that staff have completed the mandated reporter training and have proof of immunization for measles and pertussis, and a statement declining the flu shot. LPM obtained a copy of the facility roster, which the licensee indicated is up to date. LPM observed that the licensee is operating within the ratio and capacity of the license today.

Incidental Medical Services (IMS) policy was discussed. 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 licensee stated that there are no children enrolled at this time, who require medication while in care.

Licensee is 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. LPM reviewed the individuals associated to the license, and the licensee confirmed that everyone who is required to have a criminal record clearance is associated. Licensee was reminded of the responsibility as a mandated reporter. The licensee was reminded that the mandated reporter training needs to be renewed every 2 years, at www.mandatedreporterca.com. LPM reviewed reporting requirements for unusual incidents and injuries requiring medical attention. Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to sign up to receive quarterly updates by email by sending a request to ChildCareAdvocatesProgram@dss.ca.gov. LPM discussed the new safe sleep regulations.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site visit was given to Licensee, and Licensee was reminded that it is required to be posted for 30 days. An exit interview was conducted and appeal rights were provided.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC809 (FAS) - (06/04)

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