073407754-7-8-2022-02-CC-MMAR-CG5Q29-20220708114647

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407754
Report Date: 07/08/2022
Date Signed: 07/08/2022 11:47:06 AM

Document Has Been Signed on 07/08/2022 11:47 AM - 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:	TALEBZADEH, TARA		FACILITY NUMBER:	073407754
ADMINISTRATOR:	TALEBZADEH, TARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 812-1434
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94598
CAPACITY:	14	CENSUS: 9	DATE:	07/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Tara Talebzadeh		TIME COMPLETED:	12:00 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	On 7/8/22 at 8:30 am Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual Inspection at Tara Talebzadeh's Family Child Care Home. LPA met with Licensee, Tara and explained the purpose of today’s inspection. LPA was granted permission to enter the facility. Present in the home were Licensee, her adult daughter/Assistant, spouse and 6 day care children. By 10:15 am 3 more children arrived, bringing total number of children present at 9 (2 infants, 7 preschoolers). Facility is in compliance with required ratios today. Days and hours of operation are Monday - Friday from 7 am - 6 pm. . LPA toured the INDOOR spaces of the home with Licensee. Single story home consists on 3 bedrooms, Office, 3 bathrooms, Kitchen, Dining, Family room, Living room, Laundry room, attached garage In Use Areas: Family room, Living room (naps), Bedroom #2 (naps), Laundry room leading to Bathroom Off Limit Areas: Office, Kitchen, Dining area, Master Bedroom, Master Bathroom, Bathroom in Hallway next to master bedroom, Garage turned into daughter's bedroom. 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 Assistant. 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. LPA observed a crib in the off limit Master Bedroom. Licensee states she uses the crib for her grandson whenever he comes but also for day care infant nap. Children do not have access to rest of the room. LPA asked her not to use the room for day care children as it is off limit and not approved for use in child care. There were no baby walkers, exersaucers, jumpers or bouncers observed on the premise during today’s inspection. The home is sanitary, orderly, and safe for the day care children. LPA did not observe any wall heaters in the home. There is a screened fireplace and no stairs inside the home. The Licensee has a working telephone in the home.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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: TALEBZADEH, TARA	FACILITY NUMBER: 073407754
	VISIT DATE: 07/08/2022

NARRATIVE

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LPA observed a fully charged fire extinguisher and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons. There is a small fish tank sitting on top of the kitchen island counter, inaccessible to children. LPA reviewed a current Children Roster, Emergency Disaster Plan LIC610A. Last fire/disaster drill was completed in 2/2022. All required postings - Parent Rights Poster PUB394, Facility License, Emergency Preparedness LIC9148 were observed posted on a wall. The Licensee states that she does not transport children. She supplies snacks and meals to the children. Food storage area was observed to be clean. Day care home appeared to be free of flies, other insects, and rodents during today’s inspection.

OUTDOOR space is the Large Backyard. In Use Areas: Main yard
Off Limit Areas: Both Side Yards, Shed in left side yard.
The outdoor space and play equipment were 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. Infants were missing Safe Sleep Log. Licensee stated she checks every 15 minutes but not aware it has to be logged. Licensee started a Sleep Log during inspection, Mandated Reporter Training is current and Licensee's certifications for CPR/First Aid expires 7/2023

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

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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: TALEBZADEH, TARA	FACILITY NUMBER: 073407754
	VISIT DATE: 07/08/2022

NARRATIVE

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Licensee stated she employed a new assistant LIDA WALIZADEH recently. She worked for 3 days providing supervision care and will be coming again today. LIDA's has working fingerprints clearance but was not associated to the license, Licensee stated she did not know how to transfer / associate fingerprints to her license. LPA verified new hire's information and associated to the license during inspection.

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, regulatory violation was observed. Licensee was provided technical assistance on Criminal Record Clearance, use of off limit areas, Sleep log, Employee records. Exit interview conducted and report was reviewed with the licensee Tara Talebzadeh. A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/08/2022 11:47 AM - It Cannot Be Edited

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: TALEBZADEH, TARA	FACILITY NUMBER: 073407754
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above. Helper LIDA WALIZADEH has worked at the day care for 3 days but is not associated to license. She has active assocaiation to another facility. This poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/08/2022
	Plan of Correction
1 2 3 4	During inspection, LPA transferred and associated LIDA WALIZADEH's fingerprints to the license. This citation was cleared today.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

LIC809 (FAS) - (06/04)

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