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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494010
Report Date: 08/23/2019
Date Signed: 08/24/2019 11:44:04 AM

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:HEDAYATI FAMILY CHILD CAREFACILITY NUMBER:
197494010
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
08/23/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Maryam Hedayati, LicenseeTIME COMPLETED:
05:15 PM
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On 08/23/2019 @ 3:20 PM, Licensing Program Analysts (LPAs) Miriam Cohen and Dalicia Adkins met with Maryam Hedayati and conducted a case management inspection for the purpose of changing the OFFLIMITS section and arrangement that was originally approved during prelicensing inspection. New facility sketches were obtained, and changes include the following:
*Guest room in the addition is now off limits (made inaccessible by putting up a wall to close entrance)
*Play yard located on the side of the house is now off limits (children entrance is through the front door)
*Th guest bedroom in the main house is now off limits (made inaccessible by door knob lock)
*The garage is off limits (made inaccessible by door knob lock)
*The pergola is off limits (made inaccessible by a gate)
*The Main Living Room shall be used for daytime activities
*The master bedroom shall be used for sleeping accommodation only
*The bathroom shall be accessible to children in care
*The kitchen is accessible to children during meal times
*The backyard is accessible to children for play
Family members residing at facility are 2 adults with one daughter (17 years old) and one son (23 months old). Licensee was advised to obtain a criminal record clearance for daughter before the age of 18.
Per licensee, a barricade for the existing wall heater is unavailable at the store (a thorough research was completed). A Written Declaration was obtained from licensee that the standing wall heaters between the main living room and the hallway will remain turned off (Pilot lights turned off).
The following corrections shall made and photos to be sent to LPA Cohen:
*Door knob locks as mentioned above
*Cover for electrical socket (living room and master bedroom)
*Latches for the drawers in entertainment center and kitchen cabinets
*Three screws added on the safety gate in the backyard
A copy of this reports was discussed and issued to licensee, Maryam Hedayati.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
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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