343623672-8-18-2020-03-CC-TWAN-BSLSPG-20200818140307

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623672
Report Date: 08/18/2020
Date Signed: 08/18/2020 02:03:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	NABI ZADEH, SOUSAN & AKHAVAN, ROKAI		FACILITY NUMBER:	343623672
ADMINISTRATOR:	NABI ZADEH, S & AKHAVAN, R		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 559-0362
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY:	14	CENSUS: 4	DATE:	08/18/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:11 AM
MET WITH:	Sousan Nabi Zadeh and Rokai Akhavan		TIME COMPLETED:	11:00 AM

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) Tanya Washington contacted Applicants Sousan Nabi Zadeh and Rokai Akhavan for the purpose of an announced pre-licensing/ change of location tele-inspection. Due to COVID19 pandemic, a tele- inspection is being conducted via Facetime. The applicant was previously licensed at facility #343622169. Applicant initially submitted an application for a large license/ change of location, however withdrew from applying for a large and proceeding with a small license application at this time. During today's virtual inspection four children were present who are related to both applicants. All individuals subject to criminal background review have obtained a criminal record clearance. Applicants plan to operate Monday- Friday from 6 AM to 7 PM. Applicant submitted a copy of mortgage statement to show control of property. A health and safety inspection was conducted inside and out. This facility is a single story home which consists of 4 bedrooms, 2 bathrooms, a living room, play room, kitchen, and backyard. The off-limit areas in the home will consist of the living room connected to the front door, three bedrooms (daughter's bedrooms, a bathroom in the hallway and both sheds in the backyard. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. The first bedroom in the hallway will be used as a play room. There is a bathroom attached to the playroom for children's use, LPA observed a washer and dryer in the children's bathroom and reminded Applicant to keep cleaning compounds out of children's reach. The fireplace located in the living room is barricaded. Toxic and hazardous items are inaccessible to children and are stored out of children's reach. Sharp knifes are stored on a drying rack above the kitchen sink. Medication is stored out of children's reach. A functioning smoke and carbon monoxide detector are functioning in the home. A 2A10BC fire extinguisher is stored under the kitchen sink. LPA observed required postings in the area where parents will be dropping off children. Applicant stated that the parents will enter the facility through a side gate. Report continues on LIC809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2020

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: NABI ZADEH, SOUSAN & AKHAVAN, ROKAI	FACILITY NUMBER: 343623672
	VISIT DATE: 08/18/2020

NARRATIVE

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Applicant Nabi Zadeh has completed the required Preventative Health and Safety course, however due to recent law change she is required to take the "stand alone" Lead Prevention training through EMSA certified instructor. Applicant's spouse is being added as a co-licensee and he is looking to sign up for the required EMSA certified 8 hour Preventative Health and Safety course. LPA verified that Sousan's CPR and First Aid is valid until 07/2021 and Rokai's is valid until 08/2021. Applicant stated there are no weapons in the home. There are no bodies of water on the premises. Applicant was encouraged to maintain supervision at all times. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed.

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

This facility evaluation report was reviewed and discussed with both applicants. LIC 311D, records, postings, and reporting requirements were discussed. LPA discussed supervision, personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes. LPA provided to Applicant by email transmission the Safe Sleep in Child Care and the Effects of Lead Exposure brochures. LPA also emailed all required licensing forms.
Upon receipt of the following:
- Rokai's proof of enrollment for 8 hour Preventative Health and Safety course.
- Sousan's proof of enrollment in "stand alone" Lead Prevention course.
Upon receipt of the above items this facility will be approved for a small family childcare license that may have a maximum capacity of up to 8 children with no more than 2 infants, with 1 child to be in Transitional Kindergarten or above and 1 child to be at least 6 years of age or older.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2020

LIC809 (FAS) - (06/04)

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