376627395-5-6-2019-20-CC-JREG-BBWU3T-20190506151404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627395
Report Date: 05/06/2019
Date Signed: 05/06/2019 03:14:09 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:	VAZIRINIA, SAYENA FAMILY CHILD CARE		FACILITY NUMBER:	376627395
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	05/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Licensee Sayena Vazirinia		TIME COMPLETED:	03:20 PM

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, Joelle Redding, made an unannounced visit for the purpose of a Random Annual inspection. During this visit, there were 3 children in care, all under the age of 2 years. The facility is within ratio and capacity. Day care hours are: Monday thru Friday from 6:30 a.m. to 5:30 p.m. LPA toured the home. Primary child care areas are bedroom off the foyer, nearby bathroom (no potty trained children today), and a side portion of the fully fenced back yard. The family room and kitchen are used on occasion as well. Licensee does have play items and a small table and chairs in the one car garage that is attached to the child care room. A Technical Advisory will be issued in reference. Off limits areas have been made inaccessible with the use of a safety gate. There are no hazardous substances accessible. There are no weapons stored in the home or on the property and there are no bodies of water present. The fireplaces have been secured. The fire extinguisher is full and of adequate size and located in the main child care room. The smoke alarm (main child care room) and carbon monoxide detector (bedroom hallway) are operational. The home is clean, orderly and has adequate ventilation and heating. Licensee has provided sufficient space for the children to eat, sleep and play within the home. Children’s toys and play equipment are safe and age appropriate. There is a working telephone and all required forms are posted. Children’s files were reviewed for emergency information. Licensee's pediatric CPR/FA certificate with A-B-Cpr is valid through 2/3/2020. SB 792 (Staff Immunizations) requirements were met at licensure. AB 1207 (Mandated Reporter Training) requirements have been met. Licensee is reminded that the training must be repeated every two years from the date of the original training which was 3/22/18. The training can be accessed at the following link: www.mandatedreporterca.com. SIDS/Safe Sleep was discussed and Child Care Providers Guide to Safe Sleep Handout provided. LPA discussed California Megan's Law and the website was provided as follows: www.meganslaw.ca.gov. Effects of Lead Exposure Handout provided for dissemination to the parents/guardians of current and future enrollees.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

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: VAZIRINIA, SAYENA FAMILY CHILD CARE	FACILITY NUMBER: 376627395
	VISIT DATE: 05/06/2019

NARRATIVE

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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, an updated Plan of Operation that includes 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 reminded that walkers, exersaucers, jumpers, bouncy seats, napping portables and drop sided cribs are not permitted for use.

Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information.

Southern California Child Care Advocate: Jane Cong-Huyen 714-703-2800 or childcareadvocatesprogram@dss.ca.gov. Contact to be placed on an email list for updated regulation information.

No deficiencies are cited.

Notice of Site Visit was posted during this visit and must remain posted for 30 days.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

LIC809 (FAS) - (06/04)

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