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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100466
Report Date: 08/04/2020
Date Signed: 08/04/2020 01:00:51 PM

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:TALACHI, BEHNAM & JAMSAHAR, MAHBOOBEH FCCFACILITY NUMBER:
376100466
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
08/04/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Benham Talachi & Mahboobeh JamsaharTIME COMPLETED:
12:15 PM
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At 10:00 am on 08/04/2020, Licensing Program Analyst (LPA), Nancy Diaz conducted a change of location pre licensing tele inspection via Face Time with applicant due to COVID-19. The 3-bedroom, 3-bath, 2-story home was toured and inspected to ensure an environment safe for the care and supervision of children. The home has a fully charged fire extinguisher size 2A10BC, smoke and carbon monoxide detector that meet requirements and are operational. All hazardous items were and secured out of reach of children. Applicant stated that the home doesn't have any bodies of water or weapon. Applicants' EMSA approved pediatric CPR and First Aid cards that are current and due to expire on October 2021. Applicants are exempt from AB1207 Mandated Reporter Training as they are not proficient in English. Their primary language is Persian. Applicants are registered to complete the required "Preventing Lead Poisoning" on August 10, 2020.

A review of the application and records on this date, it indicates that both applicants are the current adult residents at the home with the required TB clearances, caregiver background checks and child abuse clearances. Applicants have the required immunizations. Applicants are renting and has provided a copy of their lease agreement to show that they have control of the property.

Applicant will be using the following areas for childcare: living room, dining, hallway bathroom, kitchen and outside fenced yard. Off-limit areas will be: all of upstairs (3-bedrooms and 2-bathrooms) and the garage. All off limit areas has a lock, safety gate or latch to prevent day care children's access. There is a safety gate at the bottom of the stairs to ensure children's safety.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2020
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: TALACHI, BEHNAM & JAMSAHAR, MAHBOOBEH FCC
FACILITY NUMBER: 376100466
VISIT DATE: 08/04/2020
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Outdoor area will be the fenced backyard and visual supervision is required when children are outside.
Applicant was reminded of requirements for children’s records, facility roster, child abuse and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties of $100 per day, car seat law, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, baby walkers, exersaucers, bouncy seats and baby jumpers are not allowed in day care. The ABC’S of Safe Sleep: Sleep is Safest: Alone, on their Back in an empty crib on a firm mattress.
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
Applicant shall comply with all regulations and laws governing family childcare homes and be financially secure to operate a family childcare home for children.
Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at www.ccld.ca.gov . LPA discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.
Applicant has completed and submitted the family childcare self-certificate checklist. Applicant also completed the COVID-19 Child Care Program Self-Assessmeng Guide. COVID-19 information were observed posted in the child care area - proper handwashing, cough etiquette and social distancing.
Analyst read the report to applicant during the tele-inspection. A copy of the report will be e-mailed to applicant and she was advised that acknowledgement of the receipt of the report is to be received from applicant within twenty-four hours.
A provisional license is issued today pending completion of "Preventing Lead Poisoning" course. This provisional license will expire on February 3, 2021.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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