197406880-8-5-2019-30-CC-SGAN-BERUCU-20190805152830

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197406880
Report Date: 08/02/2019
Date Signed: 08/05/2019 03:28:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	ZOLFAGHARI FAMILY CHILD CARE		FACILITY NUMBER:	197406880
ADMINISTRATOR:	ZOLFAGHARI MARYAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 341-6830
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	14	CENSUS: 9	DATE:	08/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Maryam Zolfaghari		TIME COMPLETED:	03:30 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) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit .LPA met with the licensee and toured the home inside and outside at 2:05 p.m. on 08/02/2019. The licensee was present with nine children ( including two infants) and one assistant ( licensee's daughter).The licensee's home is a single story 4 bedroom, 4 bathroom home with living room, dining room, family/play room, kitchen, and attached garage. Licensee has a pool in the back yard that is properly fenced. Primary child care is provided in the children's playroom/family room in the front of the house. Children in care have access to the bathroom in the child care room. Licensee reports she has no firearms or weapons in the home. LPA also observed Licensees' current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 11/2019). Family members residing in the home include 4 adults (licensee, husband, her adult daughter and son). Napping equipment was observed. The Fire Extinguisher (2A-10-BC) was in the kitchenette area. There is a working smoke and Carbon Monoxide detectors located in the play room. The First Aid kit was observed, and complete. The back yard is being used for day care children. The back yard is fully fenced. The garage is used for storage only and is off-limits to children. The licensee is fully aware that children may not eat or sleep in the garage. The two story 1 bedroom house ( has different address) in the back is off limits to the children in care. The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The kitchenette cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care. Continued

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ZOLFAGHARI FAMILY CHILD CARE	FACILITY NUMBER: 197406880
	VISIT DATE: 08/02/2019

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

Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a).
A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card. Immunization records missing for Child #1

The following was thoroughly discussed with the licensee:

State Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. Staff immunization records are up to date. .

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

The facility is operating in substantial compliance with the Title 22 Regulations at time of visit.
No violations were cited. A copy of this report along with a Notice of Site Visit were issued and explained to licensee.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2