376300064-10-12-2022-10-CC-CHAN-CK62MW-20221012173146

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376300064
Report Date: 09/20/2022
Date Signed: 10/12/2022 05:32:06 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/12/2022 05:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	MOOSAVI-TABARSHIYADE FAMILY CHILD CARE		FACILITY NUMBER:	376300064
ADMINISTRATOR:	M. MOOSAVI-TABARSHIYADE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 228-7616
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	14	CENSUS: 11	DATE:	09/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Mahsan Moosavi-Tabarshiyade, Licensee		TIME COMPLETED:	03:24 PM

NARRATIVE

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On September 20, 2022 at 1:10 PM, Licensing Program Analyst (LPA) Cindy Hamilton and Licensing Program Manager (LPM) Carlos Martinez arrived at the facility to conduct an annual inspection as part of a compliance review. LPA and LPM met with licensee Mahsan Moosave-Tabarshiyade and toured the facility inside and out, records were reviewed, and the following was observed and/or discussed:

· Normal days and hours of operation are: Monday – Friday, 7:00 AM to 5:00 PM

· Off-limit areas include: Kitchen, upstairs bedroom and living area, downstairs bedroom and bathroom, two bedrooms off entry and bathroom, backyard and side yard (right side).

· The facility is licensed to have no more than 14 children as a large FCCH and is operating within the licensed capacity and appropriate ratios.

· Appropriate supervision provided during this inspection

· A working telephone is present, and the current phone number is on file

· A fully charged fire extinguisher (2A:10BC) was observed. A smoke detector and carbon monoxide detector were present and tested by the Licensee during this inspection.

· Fireplace is properly screened to prevent access by children in off limit area

· All hazardous items are stored inaccessible to children

· Toxins are locked

· Weapons are not present

· Stairs are barricaded

· Clean, safe and age appropriate toys

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy Hamilton	TELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE	FACILITY NUMBER: 376300064
	VISIT DATE: 09/20/2022

NARRATIVE

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· Current roster on file

· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted

· Documentation of fire and disaster drills on file – Last drill conducted on 08/12/2022

· No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Verification of control of property on file

· Children’s records are complete

· Employee’s records are incomplete, staff missing mandated reporter training

· Mandated Reporter Training completed by licensee

· Pediatric CPR and First Aid Card expire on June 2023

· Health & Safety Certificate - completed

· Resident and/or staff records were reviewed and all adults who require caregiver background checks have received all required clearances and/or exemptions.

The licensee confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

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

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy Hamilton	TELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE	FACILITY NUMBER: 376300064
	VISIT DATE: 09/20/2022

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The Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

See LIC809-D for cited deficiencies

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy Hamilton	TELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE	FACILITY NUMBER: 376300064
	VISIT DATE: 09/20/2022

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	An exit interview was conducted, and this report was reviewed with the licensee Mahsan Moosavi-Tabarshiyade. Appeal rights were discussed and provided during the exit interview. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy Hamilton	TELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/12/2022 05:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MOOSAVI-TABARSHIYADE FAMILY CHILD CARE	FACILITY NUMBER: 376300064
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES	PLAN OF CORRECTIONS(POCs)
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy Hamilton	TELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC809 (FAS) - (06/04)

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