344500131-12-4-2020-53-CC-FDIZ-BVYU7R-20201204142023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500131
Report Date: 12/04/2020
Date Signed: 12/04/2020 02:21:04 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:	ZARRABI, MISTY ANN		FACILITY NUMBER:	344500131
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	12/04/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Misty Ann Zarrabi		TIME COMPLETED:	01:50 PM

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On December 4, 2020 at 1:00 PM, Licensing Program Analyst (LPA), Fabiola Diaz met with Licensee Misty Ann Zarrabi via FaceTime video conferencing due to the COVID-19 pandemic for the purpose of an increase of capacity inspection. Licensee applied to change from a Small Family Child Care Home to a Large Family Child Care Home. Licensee's daughter and son were present during the tele-inspection. LPA observed 5 day care children present in the home.

The 1 story home consists of 4 bedrooms, three bathrooms, laundry room, 2 garages, 2 living rooms, kitchen with a dining area, play room, and a fenced back yard. Off limit areas include: all bedrooms, garages, bathrooms #2 and #3, and laundry room. Licensee acknowledged that children may never enter the off-limit areas. Licensee acknowledged that if she would like to change an off-limits area to on-limits, she will inform LPA for inspection and approval prior to using the space. Licensee stated there are no new residents in the home since licensure. All adult residents have criminal record clearances. There are no bodies of water on the premises.

During the FaceTime inspection, LPA requested a tour of the facility. LPA and Licensee conducted a health and safety tour inside and out the home. Functioning smoke and carbon monoxide detectors and a 2A10BC fire extinguisher were observed in the home. The Fire Safety Inspection Request has been cleared by Cosumnes Community Services District FD in Elk Grove as of 11/25/2020. LPA observed that there were no hazardous items accessible to children. Licensee understands that any poisons must be kept under lock and key. LPA observed the fireplace to be gated following Tittle 22. LPA observed that cleaning materials were inaccessible. Licensee stated there are no weapons in the home. Toys appear to be safe. The backyard is fenced and gated. The backyard contains a trampoline. Licensee stated that the trampoline will be removed soon, but that the day care children do not use the trampoline. Licensee stated that day care children are supervised in the back yard at all times by an adult.

LIC 809 continues on LIC 809C...

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

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: ZARRABI, MISTY ANN	FACILITY NUMBER: 344500131
	VISIT DATE: 12/04/2020

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This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. Licensee was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes. Licensee was provided with the new Safe Sleep Regulations and a list of Title 22 requirements for adults living in the facility and/or assisting with day care children.

Effective today 12/04/2020, the facility is approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without assistant, the ratios revert to those for a small family child care home.

An exit interview was conducted. A copy of this report was e-mailed to the licensee to keep on file at the facility. A “read receipt” and/or an e-mail from licensee stating licensee has read this report is in lieu of a signature due to COVID-19. Licensee stated she is able to sign the report and provide a copy to LPA.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

LIC809 (FAS) - (06/04)

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