414002957-11-29-2022-05-CC-CQUO-CLMR93-20221129114851

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002957
Report Date: 11/29/2022
Date Signed: 11/29/2022 11:49:28 AM

Document Has Been Signed on 11/29/2022 11:49 AM - 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	BAHMANIAN, SHABNAM		FACILITY NUMBER:	414002957
ADMINISTRATOR:	SHEMIRANI, B. & BAHMANIAN,		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 242-1219
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	14	CENSUS: 7	DATE:	11/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Shabnam Bahmanian & Baleen Shemirani		TIME COMPLETED:	12:00 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 November 29, 2022 at approximately 8:25am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, annual inspection. At start of LPA's visit, facility was not yet open. LPA met with licensee's assistant (A1), and explained the purpose of the visit. Per A1, licensee temporarily stepped out of facility and will return shortly. LPA was granted entrance to home by A1. The home is a multi-level, single, family home. The DAY CARE AREAS are the living room (main classroom), dining area, bathroom #1, nap/playroom (lower level), isolation area (located near kitchen), and backyard area. The OFF LIMIT AREAS are 3 bedrooms, bathroom #2, kitchen (pass by only), and laundry area. LPA observed off limit areas to be made inaccessible with child safety door handles and/or child safety gates. At approximately 9:00am, licensee and facility director (A3), arrived to facility. Present during LPA's visit included licensee, A1, A2, A3, and 7 enrolled children (all preschool age). Facility is operating within capacity limits and ratio during LPA's visit. All adults living and/or working in the home have a criminal record clearance on file. Hours of operation are Monday to Friday 8:30am to 4:30pm. Facility operates as a Persian Immersion program. LPA inspected day care areas, inside and outside the home, for health and safety hazards. The home was observed to be clean, with proper ventilation and temperature. LPA observed electrical outlets in day care areas to be made inaccessible with child safety covers and/or blocked by furniture. There were a variety of age appropriate toys and equipment that were in good working condition. LPA observed bathroom to be clean and in proper working condition. Cleaning supplies, poisons, and other chemicals were made inaccessible to children in off limit areas or stored in facility's high cabinets and shelves. The entire backyard is fully fenced with an at least 5 ft. high fence. LPA did not observe any pools, spas or bodies of water on the property. Backyard is equipped with sufficient toys that were in good working condition. Additional shade is provided to children when needed through a designated tent/ tarp. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BAHMANIAN, SHABNAM	FACILITY NUMBER: 414002957
	VISIT DATE: 11/29/2022

NARRATIVE

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LPA observed home to be equipped with a working smoke detector and carbon monoxide detector, multiple fully charged fire extinguishers and a working telephone on site. Phone number listed for Licensee is current. Per A3, there are no weapons or firearms in the home.

LPA reviewed nine children's records which were complete. Children's files have a record of emergency identification information on file. LPA reviewed licensee, A1, A2, and A3's files which were also complete. All staff (including licensee) on site during LPA's visit have a current, CPR certification that will expire 02/2023. All staff on site during LPA's visit also have a valid Mandated Reporter certificate as well as required immunizations that were made available for review. Last emergency drill conducted was 11/17/2022. Emergency drills are conducted at least once every six months and are properly logged.

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: 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/process

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.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BAHMANIAN, SHABNAM	FACILITY NUMBER: 414002957
	VISIT DATE: 11/29/2022

NARRATIVE

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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.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Shabnam Bahmanian, and facility director, A3.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC809 (FAS) - (06/04)

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