<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627637
Report Date: 02/11/2021
Date Signed: 02/11/2021 08:56:28 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:FARIDVASMENJI, FARIBA FAMILY CHILD CAREFACILITY NUMBER:
376627637
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
02/11/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Fariba FaridvasmenjiTIME COMPLETED:
08:45 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
An unannounced case management inspection was conducted with Mrs. Fariba Faridvasmenji. The purpose of this inspection is to follow-up on the corrections to deficiences cited on 2/2/2021. This inspection was conducted virtually via Zoom due to COVID-19 pandemic restrictions. Licensee's daughter Nazanin Khoshbafsorkhab was observed present (feeding a child in a high chair). Observed present today were 3 infants.
A tour of the home was conducted. The following corrections were observed:

1. CCR, Section 102417(d) - The baby bouncer was removed from the daycare area and is no longer in use.
2. CCR, Section 102417(g)(4) - Mrs. Faridvasmenji installed a latch to make the toxic items underneath the bathroom sink inaccessible to children.
3. CCR,Section 102417(g)(9)(A) - Mrs. Faridvasmenji conducted a fire drill on 2/3/21. She stated that she is aware that disaster drills are to be conducted every 6 months.
4. CCR, Section 102417(g) - Door knob covers were installed to make rooms that were designated as "Off Limits" inaccessible to children.

It was also observed today that Mrs. Faridvasmenji installed a barricade to make the kitchen inaccessible to children.

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.
A license for the increase of capacity to 14 children is granted effective today, 2/11/21.
For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall
be either: Twelve children, no more than four of whom may be infants; or More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021
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 1