414002957-5-6-2024-05-CC-JGIL-D4ZVEF-20240506162217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002957
Report Date: 04/12/2024
Date Signed: 05/06/2024 04:22:27 PM

Document Has Been Signed on 05/06/2024 04:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 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:	04/12/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Shabnam Bahmanian		TIME COMPLETED:	04:40 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 May 6th, 2024, at approximately 1:10 PM, Licensing Program Analyst (LPA) Janet Gil conducted an unannounced, annual inspection. LPA met with licensee, Shabnam Bahmanian and explained the purpose of the inspection. Present during LPA’s visit included licensee, assistant, and 7 enrolled children (7 preschoolers). Licensee lives in home with minor child. All adults living and working in the home have criminal record clearance on file. The licensee is a large license and is operating within capacity limits and ratio. Licensee rents the home, which is a single, family home. The home consists of two levels. Hours of Operation of Day Care are 8:30 AM to 4:30 PM. Day Care Areas: living room (main classroom), dining area, bathroom #1, nap/playroom (lower level), isolation area (located near kitchen), and backyard area. Off Limit Areas: 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 1:40 PM, LPA toured day care areas of home with licensee. LPA observed the home to be in good repair with proper temperature and ventilation. Home is equipped with a variety of toys and materials that were observed to be in good working condition. LPA observed a fully stocked accessible first aid kit located in the dining room area near the kitchen entrance. LPA observed a properly barricaded fireplace in living room. LPA did not observe any accessible cleaning supplies, poisons, and solutions in day care areas. LPA observed electrical outlets to be made inaccessible with outlet covers and furniture. Home is equipped with a fully charged fire extinguisher and a dual smoke and carbon monoxide detector. LPA tested carbon monoxide detector in main nap/playroom (lower level), which was observed to be working. Licensee does not have any children in care with allergies or IMS plans. Per licensee, she provides all food for the children in care. Per licensee, she communicates with parents using her personal home land line. Continue on Page 2...

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024

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

FACILITY NAME: BAHMANIAN, SHABNAM	FACILITY NUMBER: 414002957
	VISIT DATE: 04/12/2024

NARRATIVE

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At approximately 2:30 PM, LPA observed bathroom for children's use was in proper working condition. LPA observed bathroom to include appropriate toileting equipment and sanitation products. LPA did not observe any hazardous materials to be accessible to children in the bathroom. The entire backyard is fully enclosed. The outdoor area is equipped with a variety of toys and materials. LPA did not observe any accessible bodies of water in back yard area.

LPA reviewed six children records which were complete. The children’s files have a record of emergency identification information and required immunization. LPA reviewed staff records for licensee which were incomplete. Licensee was reminded that she must keep immunization records for all her staff available for the department during annual inspections. Licensee's CPR/First Aid is current and will expire 5/2/2026. The licensee’s Mandated Reporter training certification is also current and will expire 11/26/2024. Licensee’s present assistant also has a current Mandated Reporter Certificate, as well as CPR/First Aid Certification.

Licensee has licensing documentation properly posted and available for review. The licensee also maintains a childcare roster that was made available for review. Emergency disaster drills are conducted at least once every six months. The last disaster drill was conducted on January 24^th, 2024. Per licensee, there are no weapons or firearms in the home.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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

FACILITY NAME: BAHMANIAN, SHABNAM	FACILITY NUMBER: 414002957
	VISIT DATE: 04/12/2024

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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee, Shabnam Bahmanian, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No deficiencies were cited today under CCR, Title 22, Div. 12, Chapt. 1.

A notice of site visit was given and must remain posted for 30 days.

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

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Janet Gil	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC809 (FAS) - (06/04)

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