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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402759
Report Date: 01/08/2020
Date Signed: 01/08/2020 01:17:24 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:SADEGHINEJAD. SOGHRAFACILITY NUMBER:
073402759
ADMINISTRATOR:SADEGHINEJAD, SOGHRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 825-6689
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:14CENSUS: DATE:
01/08/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:S. SadeghinejadTIME COMPLETED:
01:40 PM
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3 LPA, Hollie, met with the Licensee for the purpose of a Random Health and Safety Inspection. Present in care today are five day care children, two of the children are infants under the age of two. Also present are is the licensee fingerprint cleared assistant, Ramos, Loures. A tour of the home was conducted. The licensee has made her entire home ON LIMITS to children, however, children usually do not go into her son's bedroom or the second hall bedroom. There are no bodies of water or fire arms on the premises, per the licensee. The Licensee is present in the home and ensures that children are supervised. The Licensee understands that children are not to be placed in locked cars.

The home is orderly with heating and ventilation for safety and comfort. Poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children, are inaccessible during this visit. PLEASE SEE NEXT PAGE FOR CONTINUED REPORT.

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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 4
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: SADEGHINEJAD. SOGHRA
FACILITY NUMBER: 073402759
VISIT DATE: 01/08/2020
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Fireplaces and open face heaters are screened to prevent access by children. There is a charged 2a10bc fire extinguisher and a working smoke detector as well as a carbon monoxide detector in the home.

There are no stairs in the home. The home has toys, play equipment and materials for children. The licensee is aware that when she is temporarily absent from the home, she must ensure that a fingerprint cleared adult is present with current CPR/First Aid and have verification of immunization that includes Measles, Pertussis and Influenza (optional) or provide medical exemption signed by their Physician.

The facility is operating within her licensed capacity today. There are comfortable accommodations, furnishings and equipment for children. There is a current roster and licensee provided a copy. The licensee has current cpr/fa which expires in 10-21. The licensee understands that all person’s 18 years of age or older, who frequently visits, works or resides in the home, shall be fingerprint cleared/associated to the home and have immunization's, PRIOR to being in the presence of children. PLEASE SEE NEXT PAGE FOR CONTINUED REPORT

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: SADEGHINEJAD. SOGHRA
FACILITY NUMBER: 073402759
VISIT DATE: 01/08/2020
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LPA reviewed a sampling of children’s records for documentation of Immunization and Notification of Parents Rights. The home conducts and documents fire drills as required. The licensee was informed that parents should shown the Disaster Plan and be informed of the Relocation Sites in case the Family Day Care home has to evacuate.

LPA provided Licensee with a printed copy of the A Child Care Provider’s Guide to Safe Sleep/Best Practices documentation during the last visit, and again today.

The licensee has the required immunization's on file. The back yard continues to be fenced. Children play on moveable play equipment and older children play on the anchored play equipment. The home has no pets.

There are no children that require Incidental Medical Services. The licensee and her assistant has completed the Mandated Reporter Training which will expire at the end of the month. The licensee was informed to renew.

PLEASE SEE NEXT PAGE FOR CONTINUED REPORT

SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SADEGHINEJAD. SOGHRA
FACILITY NUMBER: 073402759
VISIT DATE: 01/08/2020
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LPA encouraged the Licensee to review our website at CCLD.CA.GOV to stay up to date and informed on Laws and Title 22 Regulations as it relates to her day care business. Licensee was informed that she can view CCLD’s website for Provider Information by the PINs.
LICENSEE WAS INFORMED THAT IF THE FACILITY IS ISSUED A DEFICIENCY NOTICE, THE PLAN OF CORRECTION MUST BE CORRECTED BY THE DATE PROVIDED OR A CIVIL PENALTY OF $100 PER DAY WILL BE ASSESSED TO THE FACILITY UNTIL THE DEFICIENCY IS CORRECTED. ADDITIONALLY, A REPEAT VIOLATION OF A DEFICIENCY WILL BE ASSESSED IN THE AMOUNT OF $250 AND $100 PER DAY UNTIL CORRECTED. Licensee is also being informed of the web address www.ccld.ca.gov for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. THE LICENSEE WAS PROVIDED A COPY OF THEIR APPEAL RIGHTS (LIC 9058 12/15) AND THEIR SIGNATURE ON THIS FORM ACKNOWLEDGES RECEIPT OF THESE RIGHTS. LPA POSTED THE REQUIRED POSTINGS FOR PUBLIC VIEWING THAT MUST REMAIN POSTED FOR 30 DAYS. THERE ARE NO DEFICIENCIES CITED DURING THIS VISIT.
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4