214005170-5-30-2019-05-CC-FBTQ-BCNSAZ-20190530134311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005170
Report Date: 05/30/2019
Date Signed: 05/30/2019 01:43:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SALIMI, SADAF		FACILITY NUMBER:	214005170
ADMINISTRATOR:	SALIMI, SADAF		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 883-6255
CITY:	NOVATO	STATE: CA	ZIP CODE:	94949
CAPACITY:	14	CENSUS: 12	DATE:	05/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Sadaf Salimi		TIME COMPLETED:	02:15 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) Farhan Bashir-Tariq met with the Licensee Sadaf Salimi to conduct an Annual Random inspection on 5/30/19. The purpose of the inspection was explained . Present there were 12 children in care with the Licensee and 2 helpers, Francisca Perezdeescobar and Marali Menchualvarado. All adults living or working in the home have fingerprints clearance on file. Licensee is operating within the capacity and ratio limit as of today 5/30/19.The operation hours are M-F, 7AM-5:30PM. Licensee provides Breakfast, Lunch, Dinner and 2 snacks. LPA and Licensee inspected the entire day care area for Health and Safety Hazards. Day Care areas: First Level: Living room, Dining area, Bathroom, Kitchen and Backyard. Off limit areas: First Level: Garage, Laundry room, Bedroom #1, Bedroom #2 and the entire Second floor. All off limit areas are properly barricaded and made inaccessible to the children in care. LPA observed that there are multiple smoke detectors and carbon monoxide detectors in the home. Detectors were not tested at the time of inspection due to children napping. Licensee states, all the smoke detectors and carbon monoxide detectors are in good working condition. Licensee states, there are no firearms or weapons in the home. Licensee states that there is no pool, spa or any other body of water in the home .Licensee states, there are no pets in the home. The house is in good repair and free of hazards with proper temperature and ventilation. There is a fully charged fire extinguisher and a working telephone available in the home. There is a First Aid kit available in the home. Cleaning supplies and chemicals are inaccessible to children, they are stored in the laundry room which is made inaccessible by use of a child proof doorknob cover. The fire place is covered with a built-in screen. The temperature in the home is comfortable. Back yard is used for the children in care, which is fully fenced around and free from hazardous materials. Stairs leading to second floor has been barricaded with a child safety gate. Continuation on next page...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SALIMI, SADAF	FACILITY NUMBER: 214005170
	VISIT DATE: 05/30/2019

NARRATIVE

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Licensee presented a current roster of the children and children's files. LPA collected a copy of the current children's roster during the inspection. Children's files had immunization records and signed parent’s rights notification forms. First Aid/CPR certification is current for the Licensee and helper Francisca. Certification of Licensee and the helper Francisca expires in August 2019 and March 2020 respectively. A log of emergency drills performed was presented and the last drill was performed in April 2019. Employee files were presented and contained the required immunization records, signed employee rights notification slips. All posting requirements are met.
LPA reminds Licensee , As of January 1, 2018, all staff is required to complete Mandated Child Abuse Reporter Training (AB1207) every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the training completion certificates for the Licensee and Francisca.
LPA encourage the facility to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
Safe Sleep Regulation, Safe Sleep Environment, Items not permitted in a home and SIDS handouts were provided to the Licensee.

>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit.
Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

LIC809 (FAS) - (06/04)

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