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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627637
Report Date: 02/02/2021
Date Signed: 02/02/2021 02:52:01 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:FARIDVASMENJI, FARIBA FAMILY CHILD CAREFACILITY NUMBER:
376627637
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
02/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Fariba FaridvasmenjiTIME COMPLETED:
02:46 PM
NARRATIVE
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On 2/2/2021 @ 12:50PM, LPA Nancy Diaz conducted an unannounced case management inspection. This inspection was conducted via zoom meeting due to COVID-19 pandemic restriction. LPA met with Fariba Faridvasmenji. A tour of the home was conducted. Observed present today were 4 infants.
Her daughter Nazanin Khoshbafsorkhab was observed present today helping with the children.

The purpose of this inspection is in reference to licensee's request for an increase of capacity. The fire clearance was received on 11/4/2020 from the Poway Fire Department for capacity of 14 children.

Children have access to the play room, daycare room, hallway bathroom and a portion of the fenced backyard. There is a swimming pool located in the yard. Mrs. Faridvasmenji walked across the pool cover. The pool cover was able to withstand the weight of Mrs. Faridvasmenji when she walked across it. Licensee stated that the children does not go past the fenced portion of the yard. Children do not use the swimming pool.

LPA observed a 3-month old infant napping in a bouncer.

Mrs. Faridvasmenji submitted her current Pediatric CPR/First Aid on 1/29/2021. Pediatric/CPR and First aid is valid thru 9/19/2022. She completed her 1 hour training course in Lead Poisoning Prevention on 1/5/2021.

TYPE A and B DEFICIENCIES WERE CITED TODAY.

Type A violation if not corrected, will have a direct and immediate risk to the health, safety, or personal rights of children in care.

Type B violation if not corrected, is a potential risk to the health, safety, or personal rights of children in care.

CONTINUED
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021
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 5
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: FARIDVASMENJI, FARIBA FAMILY CHILD CARE
FACILITY NUMBER: 376627637
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2021
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME.
The home shall provide safe toys, play equipment and materials.

This regulation was not met as evidenced by LPA's observation.

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An infant was observed napping in a baby bouncer.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: FARIDVASMENJI, FARIBA FAMILY CHILD CARE
FACILITY NUMBER: 376627637
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2021
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME.
Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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This requirement was not met as evicenced by LPA's observation. LPA observed the unlatched bathroom cabinet stored bottle of handsoap and ajax cleanser.
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Type B
02/10/2021
Section Cited

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Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement was not met as evidenced by licensee's own admission.
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Licensee has not conducted an emergency drill for over 6 months.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: FARIDVASMENJI, FARIBA FAMILY CHILD CARE
FACILITY NUMBER: 376627637
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2021
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME.
The home shall be free f
rom defects or conditions which might endanger a child.

This regulation was not met as evidenced by LPA's obervation.
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The areas that were designated off-limits to children were accessible. These are the 3 bedrooms, kitchen and dining room.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: FARIDVASMENJI, FARIBA FAMILY CHILD CARE
FACILITY NUMBER: 376627637
VISIT DATE: 02/02/2021
NARRATIVE
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An increase of capacity will be granted as soon as Mrs. Faridvasmenji submits proof of corrections to the deficiencies cited today.


An exit interview was conducted with Mrs. Faridvasmenjii . A copy of this report along with Appeal Rights (LIC9058) will be sent via e-mail to Mrs. Faridvasmenji. She will confirm receipt of these report via e-mail and the reply of confirmation will serve as the signatures acknowledging these rights.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5