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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405382
Report Date: 02/07/2023
Date Signed: 02/07/2023 01:08:09 PM


Document Has Been Signed on 02/07/2023 01:08 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:SHAHBAZ, AMENEH TFACILITY NUMBER:
073405382
ADMINISTRATOR:SHAHBAZ, AMENEH TFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 212-3479
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY:14CENSUS: 9DATE:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Ameneh ShahbazTIME COMPLETED:
01:30 PM
NARRATIVE
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On 2/7/23 at 11:45 am Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Required Annual Inspection at Ameneh Shahbaz's Large Family Child Care Home. LPA met with Licensee, Ameneh and explained the purpose of today’s inspection. LPA was granted permission to enter the facility. Present in the home were Licensee, 1 Assistant, Spouse (also Assistant) and 8 day care children (3 infants, 5 preschool age). At 12:20 pm Licensee left to pick up a child (preschooler) from school and census became 3 infants, 6 preschoolers (total 9). Facility is in compliance with required ratios today. Days and hours of operation are M- F from 6:30a-6:00p. Adults living in the home are Licensee, Spouse and adult daughter, all have Criminal Background Check Clearances.

LPA toured the INDOOR spaces of the home with Licensee. It is a two story home.
ON LIMITS: Entire first floor - Living, Family room, Play room, Kitchen, 1 Bathroom
OFF LIMITS: Garage and Laundry room on Lower Level and Entire second floor
LPA observed sufficient materials, toys, and play equipment for the day care children in the home. Children were engaged in various activities under the supervision of the Licensee and Assistants. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers, jumpers or bouncers observed on the premises during today’s inspection. The home is sanitary, orderly, and safe for the day care children. Fireplace and stairs are barricaded. LPA observed a fully charged fire extinguisher and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home. LPA reviewed a current Children Roster, Emergency Disaster Plan LIC610A. Last fire/disaster drill was completed in June 2022. LPA reminded drills should be conducted every 6 months and next drill is due. Licensee agreed to do one soon. All required postings were observed posted on a wall. The Licensee transports children. She supplies snacks and meals to the children. Food storage area was observed to be clean.

OUTDOOR space was inspected and play equipment was observed to be maintained in safe condition and free of hazards. The yard was fenced and there were no bodies of water. FILE REVIEW: Children, Licensee, Assistant files reviewed, contained all required documents. Mandated Reporter Training is current and certifications for CPR/First Aid expire on 9/2023.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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: SHAHBAZ, AMENEH T
FACILITY NUMBER: 073405382
VISIT DATE: 02/07/2023
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Supervision of children was discussed with the Licensee and she understands that she must be present in the home during 80% of the operating hours of the day care and ensure that the children are supervised at all times.

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) 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
Licensee was reminded that all adults 18 and over living or working in the home, 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.

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.

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, no regulatory violations were observed.
Exit interview conducted and report was reviewed with the Licensee, Ameneh Shahbaz.
A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC809 (FAS) - (06/04)
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