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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493095
Report Date: 07/12/2019
Date Signed: 07/12/2019 03:26:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:NABIPOURKASMA FAMILY CHILD CAREFACILITY NUMBER:
197493095
ADMINISTRATOR:NABIPOURKASMA, SAREHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 360-7755
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY:14CENSUS: 9DATE:
07/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Sareh NabipourkasmaTIME COMPLETED:
03:35 PM
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On 7/12/2019 at 1:10 p.m., Licensing Program Analyst (LPA), Brianna Reynoso and Licensing Program Manager (LPM), Mariela Ramon were greeted by above facility’s licensee, Sareh Nabipourkasma. LPA and LPM were at the facility to conduct an unannounced random annual inspection. They disclosed the purpose of the visit and were granted entry by licensee, who guided them on a tour of the facility.

Upon arrival, LPA and LPM observed nine children under the care of the licensee and her assistant.

The facility's hours of operation are Monday through Friday 6:30 a.m. to 6:30 p.m. The licensee provides snack and lunch, and is currently enrolled in a food program. Per the licensee, there are no pets in the facility and they do they transport children in care.

This is a single story, four bedroom, two bathroom home with an attached garage. Main care is provided in the den also known as the day care area and the napping room located to the left of the hallway. The children use the bathroom located to the right of the napping room. The backyard is used for outside play. The off limit areas include the kitchen, living room, three of the four bedrooms, one of the two bathrooms, and the attached garage.

The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There are age appropriate toys and equipment on the premises. Per the licensee there are no weapons or firearms of any kind in the facility at this time, nor did the LPA observe any weapons during the inspection. Licensee stores medication in the off limits living room, and sharp knives are stored in a cabinet in the off limits kitchen area.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: NABIPOURKASMA FAMILY CHILD CARE
FACILITY NUMBER: 197493095
VISIT DATE: 07/12/2019
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The backyard is used by the children for outside play. The backyard is gated all around. The outdoor play area was inspected and play equipment was observed to be free of hazards, loose and sharp parts. There are no bodies of water at the family day care home. LPA observed age appropriate toys inside and outside of the home.

LPA and LPM observed a trampoline in the backyard. During the inspection, licensee provided a declaration stating her plan on ensuring the children's safety when using the trampoline. Licensee stated she has a trampoline policy in which only one child is allowed inside at a time, and she and her assistant stand on opposite ends of the trampolines in order to have visual observation of the children in care. Licensee has also placed a gate around the bottom portion of the trampoline in order to ensure the children cannot go underneath the trampoline.

The facility’s fire extinguisher (2A10BC) met the State Fire Marshal standards. The licensee provided LPA with a receipt indicating it was last purchased on 4/27/2019. Licensee tested the smoke detector and carbon monoxide detector at 2:45 p.m., and found them to be in operable condition. The facility annual fees are current. The parent board was reviewed and had all of the required forms posted and accessible to parents.

Children and staff files were reviewed and found to be complete. The facility roster and fire drills were up to date, and all individuals living the family child care home have been fingerprinted and associated to the facility. The licensee has a current CPR and Pediatric First Aid certification, which expires on 6/23/2020. The licensee provided LPA with proof of immunizations for herself and her assistant, and her Mandated Reporter Certificate, which was obtained on 11/4/2018.



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: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: NABIPOURKASMA FAMILY CHILD CARE
FACILITY NUMBER: 197493095
VISIT DATE: 07/12/2019
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The following were discussed:
There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present. Baby walkers, baby jumpers, baby exersaucers, baby bouncers/rockers and any other item that falls into that category are not permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements. LPA also provided licensee with the new 2019 Safe Sleep in Child Care brochure.

The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.



The licensee was reminded it is his/her responsibility to visit the departments website to obtain licensing forms, Quarterly Updates, and Provider Information Notices (PINs): www.ccld.ca.gov

Child Care Advocates:
To sign up for our Quarterly Updates please email the Child Care Advocates at
childcareadvocatesprogram@dss.ca.gov & (916) 654-1541.

The facility was in compliance per Title 22 regulations, and no deficiencies were cited today.

An exit interview was conducted, a copy of this report, and notice of site visit were provided to licensee, Sareh Nabipourkasma










SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Brianna ReynosoTELEPHONE: (661) 568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3