376100624-5-12-2021-51-CC-TBLK-C2XQ7Y-20210512115555

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100624
Report Date: 05/12/2021
Date Signed: 05/12/2021 12:03:03 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:	REZAEE, SHEKIBA FAMILY CHILD CARE		FACILITY NUMBER:	376100624
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/12/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Shekiba and Khan		TIME COMPLETED:	11:45 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 unannounced tele-inspection with with the applicant and her husband, Khan, due to COVID-19 State of Emergency. The purpose of the visit is to verify that the licensee remains in substantial compliance with the health & safety standards as required by regulations governing family child care homes to increase the license capacity. No children were present at the child care, licensee currently cares for school-age children. Licensee has all appropriate forms posted. CPR/ First Aid expired April 2021, licensee is enrolled in online course with Amerimed and scheduled for hands on session 5/17/21. LPA confirmed with licensee that all adults residing in the home have criminal record/TB clearances. The 2 story home was toured and inspected to ensure an environment safe for the care and supervision of children. Fire clearance was granted 3/30/21. LPA observed the required fire safety equipment and exit signs posted throughout the home and outdoors and discussed conducting drills and documenting them at least every 6 months. 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 on the property. Licensee states that there are no weapons in the home. 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. No changes have been made since the pre-licensing inspection conducted 2/17/21. The same rooms will be used for child care and off-limits areas remain inaccessible to children. LPA observed the child safety gate at the bottom of the staircase. No IMS provided at this time. Applicant 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.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

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: REZAEE, SHEKIBA FAMILY CHILD CARE	FACILITY NUMBER: 376100624
	VISIT DATE: 05/12/2021

NARRATIVE

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A large family day care home may provide care for more that 12 children and up to and including 14 children, if all of the following conditions are met:

(a) At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.

(b) No more than three infants are cared for during any time when more than 12 children are being cared for.

(c) The licensee notifies a parent that the facility is caring for two additional schoolage children and that there may be up to 13 or 14 children in the home at one time

Licensee is aware that her own children under age 10 are counted in the capacity.

No deficiencies are cited. Licensee will submit proof of CPR/ First Aid upon completion; a provisional license for 14 will be issued effective today, 5/12/21 and expires in 30 days.

The licensee was provided a copy of this licensing report and their appeal rights (LIC 9058 12/15) by email. Licensee will acknowledge receipt of these rights by replying to the email. A Notice of Site visit was also provided by email and must be posted for 30 days.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra Block	TELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

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