<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406962
Report Date: 02/06/2020
Date Signed: 02/06/2020 03:01:25 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:HABIBI, FARIDEHFACILITY NUMBER:
073406962
ADMINISTRATOR:HABIBI, FARIDEHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 231-5924
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY:14CENSUS: 9DATE:
02/06/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:HABIBI, FARIDEH, LICENSEETIME COMPLETED:
03:10 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
Licensing Program Analyst (LPA) Redmond, arrived at the facility on 02/06/20 at 01:30 PM, to conduct an inspection to ensure the Licensee is in compliance with Title 22, CCR and Health and Safety regulations. During the inspection, LPA met with HABIBI, FARIDEH, LICENSEE. Licensee accompanied LPA during the inspection. During the inspection, the LPA made the following observations:

Capacity/Staffing: The facility operates as a Family Day Care, large, with a capacity of up to 14 children. Currently, there are nine (9) children present, including some infants. There are three (3) staff present, including the Licensee. The facility meets personnel to child staffing requirements and maximum capacity limits.

"On Limit" Areas (accessible to children in care):

· Living/family room: there are safe toys, play equipment and materials which appear age appropriate and adequate for the children in care
· Restroom (one): available for children’s use. The toilet and sinks are in good repair
· Backyard/Outdoor play area: Gated. Toys are in good repair and appear safe. There are no pools, hot tubs or other bodies of water.

"Off Limit" Areas (not accessible to children in care):

· Upstairs, barricaded by gate
· Kitchen
· Sheds (located in back yard)
CONTINUED
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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 2
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: HABIBI, FARIDEH
FACILITY NUMBER: 073406962
VISIT DATE: 02/06/2020
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
26
27
28
29
30
31
32
Emergency Preparedness/Safety: LPA observed smoke and carbon monoxide detectors present, however, children were napping, therefore the detectors not tested. LPA has advised the Licensee to test equipment regularly. There is a fully charged fire extinguisher, with an appropriate classification of (3-A:40-B:C). Emergency Disaster Plan is dated current, per Licensee. Facility utilizes a land line for telephone service. Per the Licensee, there are no firearms present. The Licensee is not currently providing *Incidental Medical Services (IMS) for children in care.

Training/Record Review: LPA verified that the Licensee and adults residing in the home, have criminal background clearances and are associated to the facility. Licensee has current CPR/First Aid training, which, expires in 09/21. Licensee and staff have completed Mandated Reporter training, on 02/18/18. LPA reminded Licensee that the Mandated Reporter certifications on file will be expiring next month. Licensee provides care for at least one infant and was aware of upcoming, Safe Sleep requirements. LPA discussed Safe Sleep with Licensee. A link has been provided for additional information: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep


Posted as required: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist. Not posted as required: If You See Something, Say Something, PUB 475. LPA discussed this requirement with Licensee and informed her that the form is available online.

Overall, the facility is clean and orderly and in good repair. There is heating and ventilation. There are safe, healthful and comfortable accommodations, furnishings and equipment.
NO DEFICIENCIES CITED ON THIS DATE
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2