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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073404853
Report Date: 02/15/2023
Date Signed: 02/15/2023 03:54:36 PM


Document Has Been Signed on 02/15/2023 03:54 PM - It Cannot Be Edited

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:AMIRKHANI, ARMINEHFACILITY NUMBER:
073404853
ADMINISTRATOR:AMIRKHANI, ARMINEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 954-8068
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:14CENSUS: 3DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Armineh AmirhaniTIME COMPLETED:
04:00 PM
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On 02/15/2023 at 1:00 PM, Licensing Program Analysts (LPAs) Christina Watts and Monica Mathur conducted an unannounced annual inspection for Armineh Amirkhani's large family child care home. LPAs met with licensee and guided analyst on a tour of the facility. During today's inspection, there were 3 children in care (3 preschool aged children) with an assistant and 7 children enrolled. Family members residing in the home are licensee, licensee husband and licensee adult child. Licensee and all adults have criminal background clearance. Facility hours of operations are Monday - Friday from 7:30 AM - 4:30 PM.

This is a one story home which consists of 3 bedrooms, 3 bathrooms, main kitchen, family room, dining room ,living room, laundry room, detached garage, small kitchen, 3 additional rooms(2 large play rooms and a nap room) backyard with an anchored play structure with secured swing set and a locked shed. Entrance is through driveway side gate between detached garage and main home
The children on limits areas: Back of the home; 3 rooms (2 large play room and a nap room), hallway, bathroom and center of backyard near back of the home.
Areas off limits include: Front of house which includes 3 bedrooms, 2 bathrooms, family room, laundry room, living room, detached gargage, shed, far right of backyard and area behind play structure, small kitchen in the back of home.
The LPAs toured all areas used by children during this visit.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating system for safety and comfort. There were safe toys, play equipment and materials observed for children. There are no stairs in the home. There is a working telephone in the home. Detergents, poisons, cleaning compounds, medications, and other items which can pose a danger to children are made inaccessible in the home.

*CON'T ON PAGE 2*

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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: AMIRKHANI, ARMINEH
FACILITY NUMBER: 073404853
VISIT DATE: 02/15/2023
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*PAGE 2*

Per licensee, there are no weapons or firearms in the home. Licensee has an up to code 3A40BC fire extinguisher and working smoke/carbon monoxide detector on the premises. Licensee last conducted fire drill 01/25/2023. Licensee stated she does not have any pets in the home.

LPAs inspected the backyard. LPA observed a fully fenced and safe backyard for children in care. LPAs observed anchored play structure with a swing set as well as age appropriate toys for children to play with. LPAs observed far right area of backyard is fenced and made inaccessible to children in care. LPAs observed on the left hand side of the backyard behind the play structure that children are able to access area. LPAs discussed with licensee that outdoor area behind the play structure has to be made inaccessible to children in care. LPAs also discuss visual supervision of children in that specific area. LPAs discussed with licensee to update the facility sketch as facility sketch is out of date. Licensee stated she will update facility sketch and turn the sketch into licensing. LPAs did not observe any bodies of water. Facility does not provide transportation for children, but licensee understands that children cannot be left alone, unattended in parked vehicles

Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The licensee Pediatric First Aid and CPR certificate will expire in 05/2024 Required postings were observed near the entrance.

On or before March 30, 2018, any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Licensee has provided Mandated Reporter certificate and the certificate will expire 11/2023.



LPA reminded licensee day care needs to be operated within the limitations and capacity of a Large Family Child Care Home with regards to ratios and that Licensee has to be present in the day care for 80% of the operation hours.

*CON'T ON PAGE 3*
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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: AMIRKHANI, ARMINEH
FACILITY NUMBER: 073404853
VISIT DATE: 02/15/2023
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*PAGE 3*
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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) Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

In the areas that were evaluated, there were no violation observed.

Exit interview conducted and report was reviewed with the licensee, Armineh Amirkhani. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4