304313559-12-7-2020-06-CC-KDEI-BW3SPZ-20201207130357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313559
Report Date: 12/07/2020
Date Signed: 12/07/2020 01:04:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	AKBARI PAZOOKI, PANTEA		FACILITY NUMBER:	304313559
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	12/07/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Licensee Ms. Akbari Pazooki Pantea		TIME COMPLETED:	01:15 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) Ketki Desai conducted an unannounced In-person Case Management License initiated inspection for a change in capacity at the existing Family Child Care home. LPA met with Licensee Ms. Akbari, Pantea, who gave a tour of the home. At the time of inspection there were 2 infants and 3 preschool age children in care. A review of the Facility Personnel Report Summary indicates all adults, residing in the home who require caregiver background check clearances are cleared Licensee is requesting a Large family childcare home license. Per Licensee, operation hours will be Monday to Friday, 8:00AM to 6:00PM. Licensee states that she will care for children Newborn to School age children (10) All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story home that consists of 5 bedrooms, 3 restrooms, family room, living room, kitchen, dining area, backyard with Pool and a garage. There is a stairway in the home which has a child safety gate making it inaccessible to children. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license, she was informed if any changes are to occur, Department shall be notified. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a central Air /Heating system, the A/C unit is installed in the side yard with an installed fenced barrier around it. There is a fireplace in the day care area, and was observed to have a safe barrier, there is also a second fireplace in the formal living area (inaccessible to children) with a metal barrier in front serving as a safe barrier. (Page -1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: AKBARI PAZOOKI, PANTEA	FACILITY NUMBER: 304313559
	VISIT DATE: 12/07/2020

NARRATIVE

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Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock.

Based on the Facility Sketch submitted, areas off limits to children and parents are: All of upstairs which include 4 Bedrooms, 2 bathrooms, which was made inaccessible by child safety gate. Attached garage, laundry room, and kitchen located adjacent from the family room are made inaccessible by child safety latch and gate. Backyard pool area behind the house is made inaccessible by fence. Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA, also observed COVID19, precautions at the facility, with required postings, temperature checks upon arrival, social distancing and activities being held in small groups.

Areas Designated for Day care activities: Children shall enter the home through the front entrance, they walk through the passage into the family room designated a Child care area and it has a safety gate making the other areas of the home inaccessible, the bathroom designated for day care use is in the hallway adjoining to the family rooms and was observed to be safe and free of hazardous items. There is a sink cabinet inside the bathroom and no hazardous were observed, made inaccessible by a child safety latch and a lock. Bathroom was clean.

Next to the door leading the garage and was locked. Family room is open and designated for day care activities, Bedroom on the right side upon entering the home is the designated room for napping, only young infants nap in the family room in a play pen so ongoing supervision is provided while older infants/ toddler nap in the napping room in the play pen. Per Licensee toddlers and preschoolers do not take naps but she does have napping items if needed.

The two designated rooms were observed to have age appropriate furniture, toys and educational materials for children in care.

OUTDOOR PLAY AREA: Backyard is designated for outdoor play area, it is fenced and has concrete flooring on the side with grassy area in the middle, which is shaded, age appropriate outdoor toys were observed. Fencing is placed around the pool area, which serves as a barrier. (page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: AKBARI PAZOOKI, PANTEA	FACILITY NUMBER: 304313559
	VISIT DATE: 12/07/2020

NARRATIVE

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Bodies of Water: Licensee has one pool and Jacuzzi in the back yard. The pool has one black 5 feet high fencing as well as one fencing on the other side making it completely inaccessible to children, fence is not easily climbable by children. The gate of black metal fence outside the pool area has a locked gate swinging away from the bodies of water (Pool and Jacuzzi), it is self-latching, this self-latching device is located on the top of the gate. Licensee has installed a mesh around the outer metal fencing.
There is no window or door providing direct access to the pool or the jacuzzi, it is enclosed fencing surrounding the pool.
Horizontal white beams are 45 inches apart and opening between the pickets are no than 4 inches.
Fencing around the pool meets the regulation and is safe for children to play in the open space.

Per applicant, there are no pets, firearms, weapons or bodies of water on the premises.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

There are toys available for children. Cots shall be used during napping time, linens and blankets shall be provided by the parents. Young infants shall use cribs and playpens.

All the items needed for Infant care (Diapers/ Wipes/ Creams/ lotions/ Food/ Formula are be provided by the parents, the items shall be stored and labelled with name and date.

Licensee states that she provides Breakfast/ Lunch and snacks for children in care. Food brought from the children’s homes, those containers shall be labeled with child’s name and properly stored or refrigerated.

Licensee has completed the required Health and Safety with Nutrition Training and Pediatric First Aid and CPR which expires 10/17/2022. There are first aid supplies available.

Licensee was made aware of Infant care and PIN 20-24CCP was also discussed with the Licensee

Licensee has a cell phone that is used for childcare. Licensee was informed if a cell phone is used for childcare, it must always remain on the premises during hours of operation.

(page- 3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: AKBARI PAZOOKI, PANTEA	FACILITY NUMBER: 304313559
	VISIT DATE: 12/07/2020

NARRATIVE

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The following was discussed with the applicant:
·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.

Civil Penalties will be assessed if not in compliance.
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.

·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
Applicant was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients. (Page-4)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: AKBARI PAZOOKI, PANTEA	FACILITY NUMBER: 304313559
	VISIT DATE: 12/07/2020

NARRATIVE

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UPDATE: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles.
The licensee has submitted proof of immunization's.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com.

Licensee provides Infant care and following was reviewed and new PIN released in September was shared.

A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:

English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

LPA reviewed with applicant the following safe sleep best practices:
Always place infants on their backs for sleeping
Use only a tight-fitting sheet on the crib or play yard mattress
Do not hang any items from the crib or above the crib
Keep all items, including blankets, out of the crib or play yard
Pacifiers may be used as long as they do not have items attached to them
Infants should not be swaddled or have any items covering them while sleeping
The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.
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: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: AKBARI PAZOOKI, PANTEA	FACILITY NUMBER: 304313559
	VISIT DATE: 12/07/2020

NARRATIVE

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OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)
 Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

Fire inspection from Anaheim Fire prevention have granted the fire clearance on 11/25/2020.

The licensee does have a current roster of children in care.

The current small family home was in compliance for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection.
A license reflectign the change in capacity shall be issued after final review, in the event additional requirements are needed, the applicant will be notified.

On today’s inspection each child was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s.

Children's files were reviewed and were met the regulations.

An exit interview conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

LIC809 (FAS) - (06/04)

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