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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623792
Report Date: 12/15/2020
Date Signed: 12/15/2020 02:01:29 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:EDALATISHAMS, AKRAMFACILITY NUMBER:
343623792
ADMINISTRATOR:EDALATISHAMS, AKRAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 239-5038
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:14CENSUS: 0DATE:
12/15/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Akram EdalatishamsTIME COMPLETED:
02:30 PM
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This is a Change of Location from previous facility number 343621088.
Licensing Program Analyst (LPA) Kelly Ferrara contacted applicant Akram Edalatishams for the purpose of a scheduled Change of Location inspection. Due to the COVID19 pandemic, a tele-inspection is being conducted via Face Time. Applicant submitted an application for a large license at her new address. LPA advised applicant that all adults living or working in the home must be fingerprint cleared and associated to her license. LPA received an approved fire clearance from the Folsom Fire Department.

A health and safety inspection of the interior and exterior of the home was conducted. Applicant's home is a single story, three bedroom two bathroom home. Off limit areas include: Master bedroom and bathroom, bedroom #2 and garage. Applicant understands that children may not enter off limit areas and any changes made must be cleared through Licensing. Chemicals, knives, medications, and hazardous items are all stored in a way that is inaccessible to children. LPA advised that poisonous items such as weed killer must be locked. LPA had the applicant test the smoke and carbon monoxide detector and observed that they are functioning properly. LPA observed a 2A-10-BC fire extinguisher. LPA observed all required licensing postings along with COVID19 posters. Applicant stated there are no firearms in the home and LPA did not observe any bodies of water on the premises.

The Facility Evaluation Report was reviewed and discussed with the Applicant. 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 advised Applicant to read all PINs regarding COVID19. LPA reviewed capacity requirements and limitations and discussed new safe sleep regulations.

Once the following item is received, a license for the facility will be issued:
Additional fingerprint clearance
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020
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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