376100624-2-17-2021-51-CC-TBLK-BYBR3D-20210217113946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100624
Report Date: 02/17/2021
Date Signed: 02/17/2021 11:40:31 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:	REZAEE, SHEKIBA FAMILY CHILD CARE		FACILITY NUMBER:	376100624
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	02/17/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Shekiba Rezaee		TIME COMPLETED:	11:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Tyra Block, conducted an announced Pre-Licensing tele-inspection for Relocation via MS Teams due to COVID-19 State of Emergency. Present with Licensee was her husband Khan who assisted with interpreting and her 2 children. The 2-story, 3-bdrm, 3baths home was toured and inspected to ensure an environment safe for the care and supervision of children. The Licensee has provided proof of control of the property. The fire extinguisher (2A10BC), 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. Licensee states that there are no weapons in the home. CPR and First Aid expire on 4/2021. Preventative Health and Safety training was completed on 4/2017. The Lead Poisoning Prevention training is pending. 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. Staff immunization requirements were met. Licensee will be using the following rooms for childcare: Living Room, Family Room, Dining Room, Kitchen, and downstairs Bathroom. Off limits areas include: the entire 2nd floor and the garage. The stairs are made inaccessible through the use of a child safety gate; a door knob cover and child proof latch are used to make the garage inaccessible. The applicant has sufficient toys and equipment available for children to use and the home has a fenced backyard available for outdoor activities. Licensee was reminded of requirements for children’s records, child abuse, and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, Licensee was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. The Effects of Lead and the current Child Care Guidance in response to COVID-19 was also discussed. LPA provided information regarding Safe Sleep Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

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 2

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: REZAEE, SHEKIBA FAMILY CHILD CARE	FACILITY NUMBER: 376100624
	VISIT DATE: 02/17/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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.

Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate information was provided and applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The following corrections are needed prior to a license for 8 being granted:

Updated Facility Sketches to show off-limit areas;
Lead Poisoning Prevention Training;
and proof of current influenza vaccine or statement to decline

A Provisional license may be granted upon receipt of the Facility Sketches and proof of the Flu Vaccine, pending completion of Lead Poisoning Prevention training.

Applicant understands that corrections must be submitted to the Department within 30 days or the application may be denied

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and this licensing report by email. Licensee will reply to the email to acknowledge receipt of these rights.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2