376627637-10-22-2021-51-CC-PMAA-C82UNM-20211022154411

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627637
Report Date: 10/22/2021
Date Signed: 10/22/2021 03:44:21 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 CARE		FACILITY NUMBER:	376627637
ADMINISTRATOR:	FARIBA FARIDVASMENJI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(858) 952-4415
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	14	CENSUS: 6	DATE:	10/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	FARIBA FARIDVASMENJI		TIME COMPLETED:	03:55 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	On 10/22/21 at 10:00am Licensing Program Analyst (LPA) Patrick Ma and Licensing Program Manager Renesha Pack conducted an unannounced annual inspection with the Licensee. Upon arrival, LPA was met with Licensee Fariba Faridvasmenji. Licensee was provided the Inspection Checklist (LIC 126). The one story, 4 bedroom, 3 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. Present in the home were the Licensee, daughter/helper Nazanin Khoshbafsorkhab and 6 day care children. Two of the six children were infants. Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include living room, office (nap room) and hallway bathroom. Off limits areas include garage, laundry room, family room, kitchen and all four bedrooms and are inaccessible through use of both metal and mess gates. The licensee has sufficient toys and equipment available. The home has a fenced backyard, and uses a enclosed patio area for outdoor activities. Licensee understands that visual supervision is required at all times during outdoor activities. There is a pool and jacuzzi in the backyard which is properly made inaccessible per regulation. The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items are latched/locked and secured out of reach of children, except for the cabinet under the built-in barbecue table outside. Licensee states that there are no weapons in the home. First Aid and CPR certifications expire on 9/19/22. Licensee has required immunizations. Licensee is exempt from Mandated Reporter Training as their primary language is not English. Children’s and Staff records were reviewed. Annual fee due 10/19/21 was also discussed with Licensee.

SUPERVISOR'S NAME: Renesha Pack	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick Ma	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: FARIDVASMENJI, FARIBA FAMILY CHILD CARE	FACILITY NUMBER: 376627637
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to children in care. Latch under the bathroom sink was loose providing potential access to cleaning solution. Cabinet, although hard to open, under the barbecue table outside could be accessed by firmly turning and pulling the handle. In the cabinet, there was hazardous primer solution, sharp tools, plastic bag, and loose wires.
	POC Due Date: 11/22/2021
	Plan of Correction
1 2 3 4	Latch was tighten during inspection but cabinet under the barbecue table will be made inaccessible and children will remain visual supervised with in outdoor play area. Licensee will send a video or picture as proof to LPA Ma the cabinet doors are secure.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above because Daughter/Helper's, Nazanin Khoshbafsorkhab, immmunization records (DTap) were not on file. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/22/2021
	Plan of Correction
1 2 3 4	Licensee will have Nazanin Khoshbafsorkhab get her DTap immunization and provided LPA MA proof of her immunization via email, patrick.ma@dss.ca.gov.

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: Renesha Pack	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick Ma	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: FARIDVASMENJI, FARIBA FAMILY CHILD CARE	FACILITY NUMBER: 376627637
	VISIT DATE: 10/22/2021

NARRATIVE

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Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

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.
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.

LPA discussed and provided Licensee with the following: child care advocates-email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

SUPERVISOR'S NAME: Renesha Pack	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick Ma	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: FARIDVASMENJI, FARIBA FAMILY CHILD CARE	FACILITY NUMBER: 376627637
	VISIT DATE: 10/22/2021

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, 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

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/inspection-process.

See LIC809D for deficiencies cited. Exit interview conducted and report was reviewed with the licensee Fariba Faridvasmenji. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Renesha Pack	TELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick Ma	TELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

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