073403929-1-9-2020-02-CC-GRED-BKNPT6-20200109103524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073403929
Report Date: 01/09/2020
Date Signed: 01/09/2020 10:36:01 AM

COMPREHENSIVE INSPECTION

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:	NOROUZI, EHTERAM		FACILITY NUMBER:	073403929
ADMINISTRATOR:	NOROUZI, EHTERAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 372-6166
CITY:	MARTINEZ	STATE: CA	ZIP CODE:	94553
CAPACITY:	14	CENSUS: 11	DATE:	01/09/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nourouzi, Ehteram, Licensee		TIME COMPLETED:	10:40 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) Redmond, arrived at the facility to conduct a health and safety inspection. The purpose of the inspection is to ensure the Family Day Care home is in compliance with Title 22, CCR and Health and Safety Code regulations and statutes. During the inspection, LPA met with Nourouzi, Ehteram, Licensee. The Family Day Care home is licensed for a capacity of up to 14 children. On this date, LPA observed eleven (11) children present and three staff, including the Licensee. The home is in compliance with capacity and personnel requirements. There are infants in care. The Licensee has designated areas in the home which children will be allowed and restricted access. Those areas are considered “on limit” and “off limit” as described below: On Limit areas where children are permitted include: · Class room: Furniture and equipment is age appropriate and in good repair. There are no baby walkers or other prohibited equipment. There are pack and play type, sleeping apparatuses which meet Safe Sleep requirements · Family room: used as a sleeping area. There is a fireplace, which is barricaded. · Living room: used as a sleeping area. · Restroom: is clean, and has a working toilet and sink. There are sanitary supplies. here are cleaning solutions or other toxins accessible to children. · Play yard: There are no observable health or safety hazards. There are age appropriate toys and equipment. CONTINUED

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

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: NOROUZI, EHTERAM	FACILITY NUMBER: 073403929
	VISIT DATE: 01/09/2020

NARRATIVE

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Off Limit areas where children are not permitted include:

· Private Bedrooms
· Private Bath

· Emergency Preparedness/Safety: There are carbon and smoke detectors, both were tested during the inspection and found to be operable. There is a fire extinguisher which, is charged and has a classification of 3 A 40: B C, which, meets fire marshal requirements. There are first aid supplies available. Emergency Disaster Plan is posted and is dated 04/01/18 and is current, per Licensee. Fire and earthquake drills were last conducted on 09/27/19 and meet six (6) month requirement. The facility utilizes a land line. The facility is not currently providing *Incidental Medical Services (IMS) for any children in care.

Training/Record Review:
Licensee and all staff present at the home have criminal background clearances and are associated to the facility. Licensee and staff have current CPR/First Aid training, which, expires on 05/06/20. Licensee and staff persons, have completed Mandated Reporter training and there are certification of completion on file. Licensee provides care for infants. LPA discussed the new, upcoming, Safe Sleep requirements.

Posted: Facility License, Emergency Disaster Plan Not Posted: Notification of Parent's Rights, Earthquake Preparedness Checklist. If You See Something, Say Something.

Staff Immunization: Licensee and staff have immunization records on file, including tuberculosis.

Overall, the home is clean, orderly and in good repair. The temperature is comfortable and there is adequate heating and ventilation. There are safe, healthful and comfortable accommodations, furnishings and equipment. There are no cleaning solutions, medications, toxins or other hazardous items accessible to children. There are no pools, hot tubs or other

CONTINUED

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

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: NOROUZI, EHTERAM	FACILITY NUMBER: 073403929
	VISIT DATE: 01/09/2020

NARRATIVE

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bodies of water present.

FACILITY IN SUBSTANTIAL COMPLIANCE. NO DEFICIENCIES CITED ON THIS DATE.

Exit interview conducted. Licensee issued a Facility Evaluation Report, which was discussed with the Licensee, signature obtained below. A copy of this report shall be maintained for 3 years and available for public review upon request.

Notice of Site Visit was issued and shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

LIC809 (FAS) - (06/04)

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