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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409070
Report Date: 05/01/2020
Date Signed: 05/04/2020 01:25:37 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:SARTIP, NAEEMEHFACILITY NUMBER:
073409070
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 45DATE:
05/01/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Naeemeh SartipTIME COMPLETED:
04:50 PM
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Licensing Program Analyst,(LPA), R. Hollie, met with Ms. Sartip, via telephone face time for the purpose of a Case Management, Change of Location Pre licensing Inspection.
A tour of the licensee's home was inspected via Face Time Tele-Inspection. Present in care at the time of the inspection were four day care children and the Licensee's 17 year old child.
This is a two story home, which consists of four bedrooms upstairs and two bathrooms, a living and dining area, a kitchen and a family room. The entire upstairs will be OFF LIMITS to day care children. There is a gate at the entry way to the stairs to prevent access by children. Additionally, the downstairs kitchen and family room as well as the garage, will be OFF LIMITS and there are gates and doors to prevent access to the latter mentioned area's. The licensee understands that children cannot have access at anytime to the OFF LIMIT area's.
Children will have access to and will utilize, the living room, dining area and the, 1/2 bath located next to laundry room, all which are located downstairs.
There is a working smoke detector and carbon monoxide detector that was tested during this visit. The home has a charged 2a10 bc fire extinguisher. The licensee stated that there are no guns or bodies of water on the premises. During the inspection, poisons were locked and cleaning compounds and medicines were inaccessible. The toilets and faucets are operable during this inspection.
The outdoor was toured via tele inspection. The entire yard is fenced and on limts. There were moveable children's play equipment outside.
PLEASE SEE NEXT PAGE FOR CONTINUED REPORT.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
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 3
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: SARTIP, NAEEMEH
FACILITY NUMBER: 073409070
VISIT DATE: 05/01/2020
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PAGE 2.
The licensee has current CPR/First Aid which expires in 04-21. The licensee states she has a first aid kit and the electrical outlets are inaccessible to children. The licensee understands that baby bouncers, johnny jumpers, saucer chairs and inclined sleepers are not allowed in licensed care. LPA discussed with the licensee, Regulatory Concepts as it relates to sleeping for children under the age of one. During this inspection, the licensee provided verification of play pens, with mattresses and tight fitting sheets. During a prior inspection at the licensee's former address, she was given the documents concerning the Safe Sleep Practices.
The licensee's 17 year old child was present. The licensee was informed that upon her child's 18th birthday, she must have her fingerprinted within 30 days. The licensee was also informed that all adults 18 years of age or older, who work, reside or frequently visits the home, shall be fingerprint cleared, have verification of immunization, including a TB test less than a year old and complete a Criminal Record Statement, PRIOR to being in the presence of day care children
The licensee was further informed that if she has to leave the day care, children shall be left with a fingerprint cleared adult, who has current CPR/First Aid and have verification of immunization's on file at the facility.
LPA, reviewed postings and children's records who were present during the inspection.
SEE NEXT PAGE
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SARTIP, NAEEMEH
FACILITY NUMBER: 073409070
VISIT DATE: 05/01/2020
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PAGE 3
The licensee has day care insurance which expires in 08-20.
The licensee stated that only her husband, her minor child and herself are the only person's who reside in the home.
The licensee is currently caring for essential worker's children due to COVID-19. There are no children who require Incidental Medical Services, per Licensee.
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.

The licensee was encouraged to review our website at ccld.ca.gov to stay up to date on Regulations at it relates to her Family Day Care License and COVID19.

Prior to issuing a license, the licensee shall send 1. A ROSTER OF CHILDREN IN CARE. 2. PROOF OF CONTROL OF PROPERTY, VIA RENTAL AGREEMENT.

The exit interview will be in the form of the licensee reviewing the report via e-mail. Upon review, the licensee will e-mail LPA to confirm that she as received, reviewed and accepts the report. The licensee's e-mail will serve as her signature and the report will be mailed to the licensee.

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020
LIC809 (FAS) - (06/04)
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