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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623792
Report Date: 12/09/2021
Date Signed: 12/09/2021 04:26:26 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: 8DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Akram EdalatishamsTIME COMPLETED:
04:40 PM
NARRATIVE
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On Thursday, December 9th, 2021, Licensing Program Analysts (LPAs) Kelly Ferrara and Arianna Manabat conducted an unannounced annual inspection and met with Licensee Akram Edalatishams. LPAs observed there were currently eight children in care with the Licensee and an assistant. Facility hours of operation are Monday through Friday 7 AM to 5:30 PM. LPAs observed proper ratio and capacity was being followed. LPA observed that the facility annual fees are current.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Off limit areas include: Master bedroom and bathroom, bedroom #2, and garage. Upon arrival, LPAs observed an infant sleeping in a play yard in the master bedroom. LPAs advised this room was listed as off limits and cannot be used for napping. LPAs conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with proper ventilation. LPAs observed the proper documents were posted where visible to parents. LPAs observed that there were no hazardous items accessible to children including cleaning compounds, medications, or sharp objects. Fire extinguisher is in working condition and accessible. LPAs observed the smoke and carbon monoxide detectors are functioning properly. The facility has adequate toys that are safe for children to use. The backyard is fenced and Licensee acknowledged that in areas that are not fenced, 100% supervision is required. LPAs did not observe any bodies of water on the premises and Licensee stated there are no firearms.

LPAs observed the Licensee has a current CPR/First Aid certificate which expires April 2023 and a current Mandated Reporter training certificate for all staff. LPAs observed fire drills were conducted at least once every six months and documented and the children’s roster is current. LPAs reviewed children’s files and observed that all the required documentation was present in each child's file.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: EDALATISHAMS, AKRAM
FACILITY NUMBER: 343623792
VISIT DATE: 12/09/2021
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



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

LPAs discussed current COVID guidelines with Licensee and provided technical assistance. LPAs provided the Department’s website WWW.CCLD.CA.GOV, so the Licensee can obtain updated licensing information, new regulations and access forms. LPAs advised Licensee of their responsibility to stay current by reviewing PINs on the website. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the licensee.

There was one Type A deficiency cited based on today's inspection. Upon receipt of Type A citations, licensee shall post and provide copies of the LIC 809 D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 809 D in each child's file
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: EDALATISHAMS, AKRAM
FACILITY NUMBER: 343623792
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above based on LPAs observed an infant sleeping in a play yard in an off limits bedroom which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/10/2021
Plan of Correction
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Licensee acknowledged that she will no longer use the master bedroom for children to nap. Licensee stated she will have the child sleep in the designated area. Licensee shall submit a picture to LPA showing that the play yard is no longer in the master bedroom and a picture of all the children sleeping in the designated area. Pictures shall be submitted by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2021
LIC809 (FAS) - (06/04)
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