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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100360
Report Date: 08/11/2020
Date Signed: 08/11/2020 11:34:44 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:DIZAYI, ROZHAN FAMILY CHILD CAREFACILITY NUMBER:
376100360
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
08/11/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rozhan DizayiTIME COMPLETED:
11:25 AM
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On 8/11/20 at 10:00 AM, Licensing Program Analyst (LPA) Keturah Lane, conducted an announced Pre-Licensing tele-inspection due to COVID-19 State of Emergency with the applicant. LPA met with Rozhan Dizayi and also present were applicant’s four children and adult cousin who was helping with translation. Applicant speaks Kurdish and Arabic. The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher, carbon monoxide detector and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home. Applicant states that there are no weapons in the home. Fireplace in living room is inaccessible by use of latch. Applicant states that they have sufficient financial resources to sustain the license. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon his/her 18th birthday must be fingerprinted within 30 days. Applicant owns the home. First Aid and CPR expire on 02/08/22 and preventative health practices course was completed on 05/02/20. Mandated Reporter Training was completed on 05/14/20. Staff immunization requirements were met. Required documents have been posted. The applicant has toys and equipment available.

Applicant will be using the following rooms for childcare: living room, dining room, kitchen, bathroom, and daycare room. The following areas will be off limits: Master bedroom and additional bedroom and garage. Off-limits are inaccessible by use of locks and door-knob covers. The home has a fenced backyard available for outdoor activities. Applicant has a covered-grill and the side yard has a gate to make it inaccessible. (continued on LIC809-C...)
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2020
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: DIZAYI, ROZHAN FAMILY CHILD CARE
FACILITY NUMBER: 376100360
VISIT DATE: 08/11/2020
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The new provider packet was reviewed with the applicant including information on child abuse reporting, children’s records, immunizations, adults living or working in the home, SIDS, Incidental Medical Services, and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed Shaken Baby Syndrome and California Megan's Law and LPA provided: www.meganslaw.ca.gov. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty Crib on a firm mattress. Applicant was provided COVID-19 resources and directed to website: www.ccld.ca.gov to receive important updates and information.

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.

No corrections are needed. A license for 8 children will be granted upon final file review. Applicant agreed to comply with all regulations and laws governing family child-care homes.

An exit interview was conducted with applicant. Appeal Rights (LIC9058) will be sent along with the report (LIC809) via e-mail to the Licensee. Licensee will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2020
LIC809 (FAS) - (06/04)
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